Healthcare Provider Details

I. General information

NPI: 1043588700
Provider Name (Legal Business Name): KAREN MARIE JEFCOAT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180-3100
US

IV. Provider business mailing address

1498 COUNTY ROAD 17
BAY SPRINGS MS
39422-7422
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-4656
  • Fax:
Mailing address:
  • Phone: 601-764-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA780
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA780
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: