Provider Demographics
NPI:1770063836
Name:JEFFERS, MELENIA KALYN
Entity type:Individual
Prefix:
First Name:MELENIA
Middle Name:KALYN
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 1:16115 SCOTT HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6460
Mailing Address - Country:US
Mailing Address - Phone:423-215-2207
Mailing Address - Fax:
Practice Address - Street 1:16115 SCOTT HWY STE 4
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6460
Practice Address - Country:US
Practice Address - Phone:423-569-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6597235Z00000X
TN6879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist