DR. ETHAN JERNIGAN (NPI# 1790305456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790305456 |
| Entity Type | Individual |
| Full Name | DR. ETHAN JERNIGAN |
| Credential | DO |
| Practice Address |
3401 W Gore Blvd Lawton OK 73505-6332 |
| Practice Telephone | 5803558620 |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2020-04-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
3401 W GORE BLVD |
| City | LAWTON |
| State | OK |
| Zip Code | 73505-6332 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295735777 | Kathleen Marie Feeley | Nurse Anesthetist, Certified Registered | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2005-07-27 |
| 1437768280 | Jordan Nixon | Speech-Language Pathologist | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-07-28 |
| 1275151953 | Tiffany Fletcher Legako | Speech-Language Pathologist | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-07-09 |
| 1669094371 | Jacob Aaron Fuller | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-05-15 |
| 1679195614 | Kennan Dale Richards | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-05-13 |
| 1730701251 | Shelby Madolyn Willis | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-05-07 |
| 1902427404 | Christopher Raul Fernandez | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-05-06 |
| 1144840802 | Lyndi Fisher | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-04-23 |
| 1629607320 | Jordan Renee Price | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-04-04 |
| 1700415403 | Hyemin April Kim | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-04-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134744006 | Angela Janell Smith | Case Manager/Care Coordinator | 4904 Nw Smith Ave, Lawton, OK 73505 | 2020-06-16 |
| 1295383990 | Akeemia Lorene Holder | Case Manager/Care Coordinator | Youth Care of Oklahoma, 713 Sw C Avenue, OK 73505 | 2019-08-27 |
| 1225685480 | Healthstat Onsite Clinic Goodyear Vision Center | Preventive Medicine | 1 Goodyear Blvd, Lawton, OK 73505 | 2019-08-22 |
| 1891285300 | Michael Anthony Gray | Case Manager/Care Coordinator | 2218 Nw 36th St, Lawton, OK 73505 | 2018-05-10 |
| 1841797362 | Adeshola T Fatuyi | Case Manager/Care Coordinator | 7301 Sw Lee 635, Lawton, OK 73505 | 2018-04-11 |
| 1912425539 | Heather Shea Morefield | Case Manager/Care Coordinator | 2712 Sw H Ave, Lawton, OK 73505 | 2017-09-04 |
| 1972031367 | Burke Hendricks | Emergency Medicine | 3401 West Gore Boulevard, Lawton, OH 73505 | 2017-05-30 |
| 1932642279 | Helery Vance | Peer Specialist | 1420 Nw Hunter Rd Apt C7, Lawton, OK 73505 | 2016-11-18 |
| 1629523436 | Sebrina Sheppard | Case Manager/Care Coordinator | 3907 Sw Parkridge Blvd., Lawton, OK 73505 | 2016-08-22 |
| 1376913590 | David Lee Atauvich | Registered Nurse | 1515 Lawrie Rd, Lawton, OK 73505 | 2015-09-30 |
| Find all providers in zip 73505 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053949123 | Shahbaz Ahmad Afzal | Student in an Organized Health Care Education/Training Program | 7108 Sw Angelwood Dr, Lawton, OK 73505-9613 | 2020-04-01 |
| 1043723257 | Caitlin Cunningham | Student in an Organized Health Care Education/Training Program | 421 Nw 69th St, Lawton, OK 73505-5403 | 2017-11-09 |
| 1831602044 | Brittany Diane Meredith | Student in an Organized Health Care Education/Training Program | 4001 Century Oaks Ln, Lawton, OK 73505-5066 | 2017-11-09 |
| 1023547510 | Courtney Hill | Student in an Organized Health Care Education/Training Program | 5404 Sw Lee Blvd Ste 101, Lawton, OK 73505-9697 | 2017-06-08 |
| 1831587419 | Katheryn Caffee | Student in an Organized Health Care Education/Training Program | 326 Ne Abshere Rd, Lawton, OK 73507-5825 | 2015-01-05 |
| 1700490570 | Kristen Renee Molloy | Student in an Organized Health Care Education/Training Program | 4202 Sw Lee Blvd, Lawton, OK 73505-8300 | 2020-08-31 |
| 1669094371 | Jacob Aaron Fuller | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-05-15 |
| 1679195614 | Kennan Dale Richards | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-05-13 |
| 1730701251 | Shelby Madolyn Willis | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-05-07 |
| 1902427404 | Christopher Raul Fernandez | Student in an Organized Health Care Education/Training Program | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2020-05-06 |
| Find all providers in LAWTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.