Provider Demographics
NPI:1417124892
Name:JAMES, KATRINA LEFAYE
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LEFAYE
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 NORTH DAVIS STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-4456
Mailing Address - Country:US
Mailing Address - Phone:904-632-2019
Mailing Address - Fax:904-632-2019
Practice Address - Street 1:3504 NORTH DAVIS STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-4456
Practice Address - Country:US
Practice Address - Phone:904-632-2019
Practice Address - Fax:904-632-2019
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL69042596172V00000X
FL08IV028385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No172V00000XOther Service ProvidersCommunity Health Worker