| Brooke A. Jernigan | |
|
302 Washington Ave Sw Ste B Roanoke VA 24016-4312 | |
| (540) 524-9918 | |
| (540) 215-7226 |
| Full Name | Brooke A. Jernigan |
|---|---|
| Speciality | Social Worker |
| Location | 302 Washington Ave Sw Ste B, Roanoke, Virginia |
| Authorized Official Name and Position | Brooke Alston Jernigan (OWNER) |
| Authorized Official Contact | 5405249918 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brooke A. Jernigan 1140 Bramlett Rd Moneta VA 24121-6246 Ph: (540) 525-0908 | Brooke A. Jernigan 302 Washington Ave Sw Ste B Roanoke VA 24016-4312 Ph: (540) 524-9918 |
| NPI Number | 1407529779 |
|---|---|
| Provider Enumeration Date | 07/31/2021 |
| Last Update Date | 10/23/2021 |
| Certification Date | 10/23/2021 |
| Medicare PECOS PAC ID | 0840694881 |
|---|---|
| Medicare Enrollment ID | O20210812001682 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407529779 | NPI | - | NPPES |
| 601531914 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Brooke Alston Jernigan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386221430 PECOS PAC ID: 7416351424 Enrollment ID: I20210812000178 |
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