Individual
MRS. KELLY R JEFFERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, FNP-BC
Contact information
Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 414-4800
(304) 414-4801
Mailing address
PO BOX 11, MOUNT CARBON, WV 25139-0011
(304) 767-8145
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
68371
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346587706
—
WV
Enumeration date
01/05/2013
Last updated
03/17/2018
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