Healthcare Provider Details

I. General information

NPI: 1619837630
Provider Name (Legal Business Name): KAITLYN MICHELLE JEFFERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PARK FORTY PLZ STE 125
DURHAM NC
27713-5249
US

IV. Provider business mailing address

1000 PARK FORTY PLZ STE 125
DURHAM NC
27713-5249
US

V. Phone/Fax

Practice location:
  • Phone: 919-912-5599
  • Fax:
Mailing address:
  • Phone: 919-912-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: