Provider Demographics
NPI:1861883225
Name:JEFCOAT, KRISHNA YVONNNE (AG-ACNP-C)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:YVONNNE
Last Name:JEFCOAT
Suffix:
Gender:F
Credentials:AG-ACNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0987
Mailing Address - Country:US
Mailing Address - Phone:251-633-0573
Mailing Address - Fax:
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR STE 1A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-343-6848
Practice Address - Fax:251-343-5708
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095574363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04802837OtherMS MEDICAID
AL511-59488OtherBCBS
AL511-59493OtherBCBS
AL10250I7971OtherMEDICARE
AL214102Medicaid
AL214217Medicaid
AL4165717OtherAETNA
AL5360280OtherUHC
AL511-59490OtherBCBS
AL224171Medicaid
AL171350Medicaid
ALP01468854OtherRR MEDICARE
AL511-59495OtherBCBS
AL512-05621OtherBCBS
AL512-05622OtherBCBS
ALZ95005OtherVIVA HEALTH