Individual
KEVEN WAYNE JEFFERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
550 SUNSET TRL, JELLICO, TN 37762-2343
(423) 784-5771
(423) 455-0380
Mailing address
107 S MAIN ST, JELLICO, TN 37762-2154
(423) 784-5771
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3646
TN
363A00000X
Physician Assistant
PA2407
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3646
STATE LICENSE
TN
05
—
7100571470
—
KY
01
—
PA2407
STATE LICENSE
KY
05
—
Q045895
—
TN
Enumeration date
08/24/2018
Last updated
03/07/2023
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