Provider Demographics
NPI:1952779555
Name:JEFFERS, DEVINN L (PA)
Entity Type:Individual
Prefix:MRS
First Name:DEVINN
Middle Name:L
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEVINN
Other - Middle Name:L
Other - Last Name:BANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2585 W HOUGHTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRUDENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48651-9624
Mailing Address - Country:US
Mailing Address - Phone:989-366-2900
Mailing Address - Fax:989-366-1166
Practice Address - Street 1:3009 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4555
Practice Address - Country:US
Practice Address - Phone:989-633-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-13
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant