Provider Demographics
NPI:1699228189
Name:JEFFUS, MICKI
Entity Type:Individual
Prefix:
First Name:MICKI
Middle Name:
Last Name:JEFFUS
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 1:3019 BRAMBLE OAKS CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3426
Mailing Address - Country:US
Mailing Address - Phone:214-476-5918
Mailing Address - Fax:
Practice Address - Street 1:3019 BRAMBLE OAKS CT
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3426
Practice Address - Country:US
Practice Address - Phone:214-476-5918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other