Provider Demographics
NPI:1487071031
Name:JEFFERY, YOLANDA (APRN)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-5801
Mailing Address - Country:US
Mailing Address - Phone:870-543-2380
Mailing Address - Fax:870-543-2368
Practice Address - Street 1:1101 S TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5801
Practice Address - Country:US
Practice Address - Phone:870-543-2380
Practice Address - Fax:870-543-2368
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004892363LF0000X
ARR084570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180635526Medicaid