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Organization
JEFFERSON STREET CLINIC LLC
Active
Organization
JEFFERSON STREET CLINIC LLC
Active
Other names
Jefferson Street Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BERYL WAYI YUFENYUY APRN (NURSE PRACTITIONER)
(240) 481-7672
Entity
Organization
Contact information
Practice address
618 JEFFERSON BLVD, LAFAYETTE, LA 70501-7206
(240) 481-7672
Mailing address
618 JEFFERSON BLVD, LAFAYETTE, LA 70501-7206
(240) 481-7672
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
NULL
261QX0100X
Occupational Medicine Clinic/Center
—
NULL
Other
Enumeration date
07/27/2022
Last updated
12/28/2022
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