Provider Demographics
NPI:1801501663
Name:JEFFERSON, ERICKA MONIQUE
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:MONIQUE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15831 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3523
Mailing Address - Country:US
Mailing Address - Phone:346-313-0858
Mailing Address - Fax:
Practice Address - Street 1:1706 CAMBRIDGE LANDING TRAIL
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545
Practice Address - Country:US
Practice Address - Phone:346-313-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty