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NPI Code Detail

MEDICARE: TIERNEY REGAN JEFFERS

MEDICARE: TIERNEY REGAN JEFFERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA7758MA
2363A00000XPhysician Assistant085011097IL

General Provider Information

NPI Number : 1508474370
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIERNEY REGAN JEFFERS
Provider Business Mailing Address
First Line : PO BOX 735263
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5263
Country : US
Telephone Number : 877-632-6637
Fax Number :
Provider Business Practice Location Address
First Line : 55 SHUMAN BLVD STE 700
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-8422
Country : US
Telephone Number : 877-632-6637
Fax Number : 708-409-5179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2020
Last Update Date : 08/13/2025

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Directions to “ TIERNEY REGAN JEFFERS ” Practice Location

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