Provider Demographics
NPI:1598519217
Name:JEFFRIES, KARINA A
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:A
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 1:7033 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1262
Mailing Address - Country:US
Mailing Address - Phone:907-729-7408
Mailing Address - Fax:907-729-6353
Practice Address - Street 1:69 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NONDALTON
Practice Address - State:AK
Practice Address - Zip Code:99640-9998
Practice Address - Country:US
Practice Address - Phone:907-729-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK23-1720-I172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker