Provider Demographics
NPI:1417324427
Name:JEFFERIS, OLIVIA (NP-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:JEFFERIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-9145
Mailing Address - Country:US
Mailing Address - Phone:740-425-5242
Mailing Address - Fax:740-425-5243
Practice Address - Street 1:1119 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-9145
Practice Address - Country:US
Practice Address - Phone:740-425-5242
Practice Address - Fax:740-425-5243
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN371339163W00000X
WVAPRN105755363LF0000X
OHAPRN24193363LF0000X
OHAPRN.CNP.024193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse