Provider Demographics
NPI:1558073429
Name:JEFFRIES, KRYSTAL D
Entity Type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:D
Last Name:JEFFRIES
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 1:5533 GWENDOLYN DR APT 102
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-0846
Mailing Address - Country:US
Mailing Address - Phone:901-690-2348
Mailing Address - Fax:
Practice Address - Street 1:5533 GWENDOLYN DR APT 102
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-0846
Practice Address - Country:US
Practice Address - Phone:901-690-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant