Provider Demographics
NPI:1962431106
Name:JEFFERIES, BARBRA DALE (RN)
Entity type:Individual
Prefix:
First Name:BARBRA
Middle Name:DALE
Last Name:JEFFERIES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2875
Mailing Address - Country:US
Mailing Address - Phone:972-247-8757
Mailing Address - Fax:972-401-9135
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-247-8757
Practice Address - Fax:972-401-9135
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX500001401OtherRAILROAD MEDICARE
TX8L17261Medicare PIN
TX500001401OtherRAILROAD MEDICARE