| Jefferson Street Clinic | |
|
618 Jefferson Blvd Lafayette LA 70501-7206 | |
| (240) 481-7672 | |
| Not Available |
| Full Name | Jefferson Street Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 618 Jefferson Blvd, Lafayette, Louisiana |
| Authorized Official Name and Position | Beryl Wayi Yufenyuy (NURSE PRACTITIONER) |
| Authorized Official Contact | 2404817672 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Street Clinic 618 Jefferson Blvd Lafayette LA 70501-7206 Ph: (240) 481-7672 | Jefferson Street Clinic 618 Jefferson Blvd Lafayette LA 70501-7206 Ph: (240) 481-7672 |
| NPI Number | 1477289817 |
|---|---|
| Provider Enumeration Date | 07/27/2022 |
| Last Update Date | 12/28/2022 |
| Medicare PECOS PAC ID | 3375915895 |
|---|---|
| Medicare Enrollment ID | O20230209003037 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477289817 | NPI | - | NPPES |
| Provider Name | Beryl Yufenyuy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649517681 PECOS PAC ID: 3779967930 Enrollment ID: I20220907002558 |
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