Healthcare Provider Details

I. General information

NPI: 1487071031
Provider Name (Legal Business Name): YOLANDA JEFFERY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S TENNESSEE ST
PINE BLUFF AR
71601-5801
US

IV. Provider business mailing address

1101 S TENNESSEE ST
PINE BLUFF AR
71601-5801
US

V. Phone/Fax

Practice location:
  • Phone: 870-543-2380
  • Fax: 870-543-2368
Mailing address:
  • Phone: 870-543-2380
  • Fax: 870-543-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004892
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR084570
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: