MEDICARE: KECIA C JEFFERS APP

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	RN290097	OH

General Provider Information

NPI Number	:	1447010913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KECIA C JEFFERS APP

Provider Business Mailing Address
First Line	:	1188 KELTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-1727
Country	:	US
Telephone Number	:	513-252-4751
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 KELTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-1727
Country	:	US
Telephone Number	:	513-252-4751
Fax Number	:

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

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/20/2024

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