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General NPI Number Information
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NPI Number | 1477378156
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Entity Type | Individual
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Provider Name | GWENDOLYN RAE JEFFERY PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 963 KIRKPATRICK RD
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City | BURLINGTON
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State | NC
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Zip | 27215-8911
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Country | US
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Telephone | 336-229-5905
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Fax | 336-252-3228
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Provider Business Mailing Address
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Address Line | 963 KIRKPATRICK RD
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City | BURLINGTON
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State | NC
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Zip | 27215-8911
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Country | US
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Telephone | 336-229-5905
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Fax | 336-252-3228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | JEFF-CYYT2
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License Number State | NC
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