Provider Demographics
NPI:1568779478
Name:JEFFERIES, STELLA KIAH (CRNP)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:KIAH
Last Name:JEFFERIES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 NEW HAMPSHIRE AVE
Mailing Address - Street 2:501
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2633
Mailing Address - Country:US
Mailing Address - Phone:301-593-8300
Mailing Address - Fax:301-593-8301
Practice Address - Street 1:11120 NEW HAMPSHIRE AVE
Practice Address - Street 2:501
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2633
Practice Address - Country:US
Practice Address - Phone:301-593-8300
Practice Address - Fax:301-593-8301
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161889363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC082735300Medicaid
MD050213800Medicaid
DC082735300Medicaid