Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 904578 | MS |
NPI | 1003497587 |
---|---|
Provider Name | Heather Lyn Jeffrey |
First Address | Gulfport, MS 39502-1810 |
Second Address | Gulfport, MS 39501-2515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2021 |
Last Update Date | 16/04/2021 |