Provider Demographics
NPI:1760457451
Name:JEFFERSON, KARI L (PA C)
Entity type:Individual
Prefix:MS
First Name:KARI
Middle Name:L
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MS
Other - First Name:KARI
Other - Middle Name:L
Other - Last Name:TOMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:608-785-0940
Mailing Address - Fax:
Practice Address - Street 1:800 WEST AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-392-9876
Practice Address - Fax:608-392-3955
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2557363AS0400X, 363A00000X
IL085003483363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P13256Medicare UPIN