Healthcare Provider Details

I. General information

NPI: 1609298926
Provider Name (Legal Business Name): KELEIGH JEFFERSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 TENNESSEE ST STE 101
VALLEJO CA
94590-4432
US

IV. Provider business mailing address

40960 CALIFORNIA OAKS RD # 1030
MURRIETA CA
92562-5747
US

V. Phone/Fax

Practice location:
  • Phone: 707-415-8409
  • Fax:
Mailing address:
  • Phone: 951-704-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number817389
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNPF95004734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: