Active NPI
Fanasy Prokop Jefcoat, D.M.D., MS
- Periodontics
- Madison, MS
National Provider Identifier
1154401909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 3251-03
- Practice address
- 101 Webster Circle
Suite 100
Madison, MS 39110 - Phone
- (601) 605-6511
- Fax
- (601) 605-6508
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 3251-03 | MS | Primary |
Addresses
Primary practice location
101 Webster Circle
Suite 100
Madison, MS 39110
Mailing address
2044 Tidewater LN
Madison, MS 39110-8927
Phone (601) 605-6511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3251-03 | MS | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486425600000",
"number": "1154401909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2044 TIDEWATER LN",
"city": "MADISON",
"state": "MS",
"postal_code": "391108927",
"telephone_number": "601-605-6511",
"fax_number": "601-605-6508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 WEBSTER CIRCLE",
"address_2": "SUITE 100",
"city": "MADISON",
"state": "MS",
"postal_code": "39110",
"telephone_number": "601-605-6511",
"fax_number": "601-605-6508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFCOAT",
"first_name": "FANASY",
"middle_name": "PROKOP",
"name_prefix": "Dr.",
"credential": "D.M.D., MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2017-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MS",
"license": "3251-03",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.