# JEFFERSON STREET CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jefferson Street Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477289817
- **Authorized official:** BERYL WAYI YUFENYUY APRN (NURSE PRACTITIONER)
- **Authorized official phone:** (240) 481-7672

## Contact information

- **Practice address:** 618 JEFFERSON BLVD, LAFAYETTE, LA 70501-7206
- **Practice address phone:** (240) 481-7672
- **Mailing address:** 618 JEFFERSON BLVD, LAFAYETTE, LA 70501-7206
- **Mailing address phone:** (240) 481-7672

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/27/2022
- **Last updated:** 12/28/2022