Healthcare Provider Details

I. General information

NPI: 1841472495
Provider Name (Legal Business Name): BARBARA ANN JEFFERS R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ORANGE ST
ABILENE TX
79601-5011
US

IV. Provider business mailing address

3142 WOODGLEN CV
ABILENE TX
79606
US

V. Phone/Fax

Practice location:
  • Phone: 325-690-5212
  • Fax:
Mailing address:
  • Phone: 325-690-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDT80522
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: