Provider Demographics
NPI:1770246175
Name:JEFFERSON, KENYA
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:JEFFERSON
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 1:7809 AIRLINE DR STE 305A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6448
Mailing Address - Country:US
Mailing Address - Phone:504-267-1234
Mailing Address - Fax:
Practice Address - Street 1:7809 AIRLINE DR STE 305A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6448
Practice Address - Country:US
Practice Address - Phone:504-267-1234
Practice Address - Fax:504-324-2094
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator