Provider Demographics
NPI:1912570052
Name:JEFFERS, VICKIE LEE
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LEE
Last Name:JEFFERS
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 1:4343 TEENS RUN RD
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-9443
Mailing Address - Country:US
Mailing Address - Phone:740-208-8714
Mailing Address - Fax:740-256-5003
Practice Address - Street 1:4343 TEENS RUN RD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-9443
Practice Address - Country:US
Practice Address - Phone:740-208-8714
Practice Address - Fax:740-256-5003
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty