Healthcare Provider Details

I. General information

NPI: 1205669678
Provider Name (Legal Business Name): MRS. YOLANDA JEFFERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WEST CAPITOL AVE STE 1700, OFFICE 1745
LITTLE ROCK AR
72201
US

IV. Provider business mailing address

400 WEST CAPITOL AVE STE 1700, OFFICE 1745
LITTLE ROCK AR
72201
US

V. Phone/Fax

Practice location:
  • Phone: 772-925-5492
  • Fax:
Mailing address:
  • Phone: 772-925-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberAR6025
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: