Keven Wayne Jeffers, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3646 Issued in TN

Practice address

550 Sunset TRL
Jellico, TN 37762-2343

Phone

(423) 784-5771

Fax

(423) 455-0380

NPI assigned

Aug 24, 2018

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, KY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dayspring Health IncGroup PAC ID 7214990746, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dayspring Health Inc

  dba Dayspring Dental

  • Federally Qualified Health Center (FQHC)
  • Williamsburg, KY
  • NPI 1871631804

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Dayspring Health Inc

  dba Clear Fork Clinic

  • Federally Qualified Health Center (FQHC)
  • Clairfield, TN
  • NPI 1013049469
  Medicare reassignment
• Dayspring Health, Inc.

  dba Dayspring Jellico

  • Federally Qualified Health Center (FQHC)
  • Jellico, TN
  • NPI 1023022084

  Multi-Specialty

  NPD
• Dayspring Health, Inc.

  dba Dayspring Regional Health Center

  • Federally Qualified Health Center (FQHC)
  • Williamsburg, KY
  • NPI 1538867551
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1609357953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 S MAIN ST",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622154",
            "telephone_number": "423-784-5771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 SUNSET TRL",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622343",
            "telephone_number": "423-784-5771",
            "fax_number": "423-455-0380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "402 Cumberland Ave",
            "address_purpose": "LOCATION",
            "city": "Williamsburg",
            "state": "KY",
            "postal_code": "407691238",
            "country_code": "US",
            "telephone_number": "423-784-5771",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5663 Highway 90",
            "address_purpose": "LOCATION",
            "city": "Clairfield",
            "state": "TN",
            "postal_code": "377153632",
            "country_code": "US",
            "telephone_number": "423-784-5771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFFERS",
        "first_name": "KEVEN",
        "middle_name": "WAYNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-24",
        "last_updated": "2023-03-07",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2407",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "3646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pedro Pablo Flores, M.D.
• Ruchi Gupta, MD
• Ronald Dennis Hartman, M.D.
• Charles R Hayes, CRNA
• HCC of Jellico LLC
• Jellico Community Hospital Inc. (Jellico Community Hospital)
• Jellico Community Hospital Inc. (Jellico Community Hospital)
• Jellico Community Hospital Inc. (Jellico Community Hospital)
• Jellico Community Hospital LLC
• Jellico Community Hospital, Inc (Jellico Community Hospital Wound Care Center)

• Physician Assistant in Jellico, TN
• Providers in Jellico, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.