Provider Demographics
NPI:1124086566
Name:JEFFERS, SHERYLL A (NP)
Entity type:Individual
Prefix:
First Name:SHERYLL
Middle Name:A
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 E COUNTY LINE RD STE D
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1068
Mailing Address - Country:US
Mailing Address - Phone:317-300-9674
Mailing Address - Fax:317-962-1818
Practice Address - Street 1:16131 N ELDRIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-9130
Practice Address - Country:US
Practice Address - Phone:713-598-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ301733363LF0000X
TX1137036363LF0000X
IN71001856A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1137036OtherTEXAS NP LICENSE
AZ301733OtherARIZONA BOARD OF NURSING
IN71001856AOtherINDIANA NP LICENSE
IN200809760Medicaid
11558545OtherCAQH