Healthcare Provider Details

I. General information

NPI: 1801960372
Provider Name (Legal Business Name): KAY JEFFERS C.A.A.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

IV. Provider business mailing address

434 JUPITER DR
NIPOMO CA
93444-8944
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6548
  • Fax: 805-934-6381
Mailing address:
  • Phone: 805-934-6548
  • Fax: 805-934-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number040896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: