Provider Demographics
NPI:1700128592
Name:TED JEFFERS
Entity Type:Organization
Organization Name:TED JEFFERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BC NNP
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:H
Authorized Official - Last Name:JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:405-974-0514
Mailing Address - Street 1:1200 EVERETT DR
Mailing Address - Street 2:ETNP7504
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5047
Mailing Address - Country:US
Mailing Address - Phone:405-271-5215
Mailing Address - Fax:405-271-1236
Practice Address - Street 1:1200 EVERETT DR
Practice Address - Street 2:ETNP7504
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5047
Practice Address - Country:US
Practice Address - Phone:405-271-5215
Practice Address - Fax:405-271-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77326282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren