Provider Demographics
NPI:1134819840
Name:JEFFERS, KAYLA SHAY
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:SHAY
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 1:2601 N PHILLIPS AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-7849
Mailing Address - Country:US
Mailing Address - Phone:405-746-4445
Mailing Address - Fax:
Practice Address - Street 1:2601 N PHILLIPS AVE APT 8
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-7849
Practice Address - Country:US
Practice Address - Phone:405-746-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist