MEDICARE: KRISTINA 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
1	3747P1801X	Personal Care Attendant
2	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1659217735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA JEFFERSON

Provider Business Mailing Address
First Line	:	9785 CROSSPOINT BLVD STE 104
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9785 CROSSPOINT BLVD STE 104
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3321
Country	:	US
Telephone Number	:	317-513-2267
Fax Number	:

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

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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