Provider Demographics
NPI:1912208489
Name:JEFFERIES, CHRISTIAN (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:JEFFERIES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:945 82ND PKWY STE 3A
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4612
Mailing Address - Country:US
Mailing Address - Phone:843-449-3381
Mailing Address - Fax:
Practice Address - Street 1:945 82ND PKWY STE 3A
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4612
Practice Address - Country:US
Practice Address - Phone:843-449-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61532367500000X
SC22196367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8248521Medicare PIN