Provider Demographics
NPI:1730678772
Name:JEFFRIES, CHASITY YVONNE
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:YVONNE
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 1:375 VANN DR STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6027
Mailing Address - Country:US
Mailing Address - Phone:731-664-0918
Mailing Address - Fax:
Practice Address - Street 1:375 VANN DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6027
Practice Address - Country:US
Practice Address - Phone:731-664-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1214191744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management