Provider Demographics
NPI:1508145517
Name:JEFFRIES, RACHELE N (PA)
Entity Type:Individual
Prefix:
First Name:RACHELE
Middle Name:N
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GREAT TEAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9816
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-201-5019
Practice Address - Street 1:503 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:ELEANOR
Practice Address - State:WV
Practice Address - Zip Code:25070-0503
Practice Address - Country:US
Practice Address - Phone:304-586-0001
Practice Address - Fax:304-586-1301
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2235363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1508145517Medicaid
WV3810020849Medicaid
WVWV0615GMedicare PIN
WVWV0615BMedicare PIN
WVWV0615EMedicare PIN
WVWV0615CMedicare PIN
WVWV0615DMedicare PIN
WVWV0615FMedicare PIN
WVWV0615HMedicare PIN