Provider Demographics
NPI:1255844791
Name:JEFFERIES, MISTEE (APN)
Entity Type:Individual
Prefix:
First Name:MISTEE
Middle Name:
Last Name:JEFFERIES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1024
Mailing Address - Country:US
Mailing Address - Phone:254-248-6268
Mailing Address - Fax:
Practice Address - Street 1:1 E CENTRAL AVE STE 209
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-7625
Practice Address - Country:US
Practice Address - Phone:512-667-7506
Practice Address - Fax:512-667-6377
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135705363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health