Provider Demographics
NPI:1629409362
Name:JEFFRIES, NATASCHA R (FNP, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:NATASCHA
Middle Name:R
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:NATASCHA
Other - Middle Name:R
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N 8TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2989
Mailing Address - Country:US
Mailing Address - Phone:618-274-9105
Mailing Address - Fax:618-274-9101
Practice Address - Street 1:100 N 8TH ST STE 120
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2989
Practice Address - Country:US
Practice Address - Phone:618-274-9105
Practice Address - Fax:618-274-9101
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000650363LP0808X
IL277.000650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209010921OtherSTATE LICENSE