Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1104584374 |
---|---|
Provider Name | Kaela Lynette Jeffery |
First Address | Plano, TX 75023-4716 |
Second Address | Plano, TX 75023-4716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2021 |
Last Update Date | 03/12/2021 |