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NPI Code Detail

MEDICARE: JEVON JEFFERSON

MEDICARE:   JEVON  JEFFERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1225462823
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEVON JEFFERSON
Provider Business Mailing Address
First Line : 6536 POINT BREAK ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-1245
Country : US
Telephone Number : 702-624-7012
Fax Number :
Provider Business Practice Location Address
First Line : 5135 CAMINO AL NORTE STE 259
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-2419
Country : US
Telephone Number : 702-806-6195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2013
Last Update Date : 08/30/2013

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Directions to “ JEVON JEFFERSON ” Practice Location

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