Basic Information
| Provider Information | |||||||||
| NPI: | 1861883225 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEFCOAT | ||||||||
| FirstName: | KRISHNA | ||||||||
| MiddleName: | YVONNNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | AG-ACNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 7987 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 MEMORIAL HOSPITAL DR STE 1A | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513436848 | ||||||||
| FaxNumber: | 2513435708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2015 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-095574 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LG0600X | 1-095574 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 04802837 | 01 | MS | MS MEDICAID | OTHER | 511-59488 | 01 | AL | BCBS | OTHER | 511-59493 | 01 | AL | BCBS | OTHER | 10250I7971 | 01 | AL | MEDICARE | OTHER | 214102 | 05 | AL | MEDICAID | 214217 | 05 | AL | MEDICAID | 4165717 | 01 | AL | AETNA | OTHER | 5360280 | 01 | AL | UHC | OTHER | 511-59490 | 01 | AL | BCBS | OTHER | 224171 | 05 | AL | MEDICAID | 171350 | 05 | AL | MEDICAID | P01468854 | 01 | AL | RR MEDICARE | OTHER | 511-59495 | 01 | AL | BCBS | OTHER | 512-05621 | 01 | AL | BCBS | OTHER | 512-05622 | 01 | AL | BCBS | OTHER | Z95005 | 01 | AL | VIVA HEALTH | OTHER |