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
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
07/27/2022
Last updated
12/28/2022
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