Provider Demographics
NPI:1235616558
Name:JEFFCOTT, KAITLYN RENEE (NP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:RENEE
Last Name:JEFFCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3388 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4553
Mailing Address - Country:US
Mailing Address - Phone:214-295-6597
Mailing Address - Fax:
Practice Address - Street 1:3388 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4553
Practice Address - Country:US
Practice Address - Phone:214-295-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1381042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology