MEDICARE: ABBY M JEFFERIES FNP-C

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
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0031458	OH

General Provider Information

NPI Number	:	1225706864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY M JEFFERIES FNP-C

Provider Business Mailing Address
First Line	:	3200 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3019
Country	:	US
Telephone Number	:	513-585-5507
Fax Number	:

Provider Business Practice Location Address
First Line	:	6645 PRINCETON GLENDALE RD
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-7547
Country	:	US
Telephone Number	:	513-829-2883
Fax Number	:	513-829-6346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	01/30/2023

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