Provider Demographics
NPI:1104584374
Name:JEFFERY, KAELA LYNETTE
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:LYNETTE
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 FRONTIER LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4716
Mailing Address - Country:US
Mailing Address - Phone:214-356-8252
Mailing Address - Fax:
Practice Address - Street 1:5004 FRONTIER LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4716
Practice Address - Country:US
Practice Address - Phone:214-356-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife