Provider Demographics
NPI:1316300031
Name:JEFFERY, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
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:PO BOX 384134
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-4134
Mailing Address - Country:US
Mailing Address - Phone:808-359-4155
Mailing Address - Fax:
Practice Address - Street 1:68-1819 PUU NUI ST
Practice Address - Street 2:
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738-5231
Practice Address - Country:US
Practice Address - Phone:808-359-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI$$$$$$$$$OtherSSN