Provider Demographics
NPI:1285724088
Name:JEFFERSON, KAREN LEE (CERTIFIED MIDWIFE)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:CERTIFIED MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1208
Mailing Address - Country:US
Mailing Address - Phone:718-230-4789
Mailing Address - Fax:866-593-2634
Practice Address - Street 1:688 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1208
Practice Address - Country:US
Practice Address - Phone:718-230-4789
Practice Address - Fax:866-593-2634
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000928367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02225689Medicaid
NYP25638Medicare UPIN
NYP25638Medicare UPIN