Provider Demographics
NPI:1205669678
Name:JEFFERSON, YOLANDA
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
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 1:400 WEST CAPITOL AVE
Mailing Address - Street 2:STE 1700, OFFICE 1745
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201
Mailing Address - Country:US
Mailing Address - Phone:772-925-5492
Mailing Address - Fax:
Practice Address - Street 1:400 WEST CAPITOL AVE
Practice Address - Street 2:STE 1700, OFFICE 1745
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201
Practice Address - Country:US
Practice Address - Phone:772-925-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR376G00000X
ARAR60253747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No376G00000XNursing Service Related ProvidersNursing Home Administrator