1861883225 NPI number — KRISHNA YVONNNE JEFCOAT AG-ACNP-C

Table of content: KRISHNA YVONNNE JEFCOAT AG-ACNP-C (NPI 1861883225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861883225 NPI number — KRISHNA YVONNNE JEFCOAT AG-ACNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEFCOAT
Provider First Name:
KRISHNA
Provider Middle Name:
YVONNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AG-ACNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861883225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7987
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36670-0987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-633-0573
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MEMORIAL HOSPITAL DR STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-343-6848
Provider Business Practice Location Address Fax Number:
251-343-5708
Provider Enumeration Date:
02/06/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  1-095574 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: 1-095574 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04802837 . This is a "MS MEDICAID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 511-59488 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-59493 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 10250I7971 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 214102 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 214217 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4165717 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5360280 . This is a "UHC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-59490 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 224171 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171350 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01468854 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-59495 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 512-05621 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 512-05622 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: Z95005 . This is a "VIVA HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".