Provider Demographics
NPI:1629209804
Name:JEFFRIES, KELLYANN (NP)
Entity Type:Individual
Prefix:MS
First Name:KELLYANN
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:YAWKEY CENTER, SUITE 7B-7700
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-724-1817
Mailing Address - Fax:617-726-0453
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAWKEY CENTER, SUITE 7B-7700
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-1817
Practice Address - Fax:617-726-0453
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262771363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner