MEDICARE: MS. RHEA J JEFFERS APRN-CNP

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.18242	OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	18242	OH
3	363LF0000X	Family Nurse Practitioner	COA.18242	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528429602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RHEA J JEFFERS APRN-CNP

Provider Business Mailing Address
First Line	:	12 W WENGER RD STE J
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2755
Country	:	US
Telephone Number	:	937-239-5644
Fax Number	:	937-771-0031

Provider Business Practice Location Address
First Line	:	12 W WENGER RD STE J
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2755
Country	:	US
Telephone Number	:	937-239-5644
Fax Number	:	937-771-0031

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

Provider Enumeration Date	:	03/16/2016
Last Update Date	:	10/03/2025

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