Keven Wayne Jeffers, PA-C
Individual provider Active NPI Physician Assistant · Jellico, TN
NPI 1609357953 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1609357953
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 3646 (TN)
- Practice address
- 550 Sunset TRL
Jellico, TN 37762-2343 - Phone
- (423) 784-5771
- Fax
- (423) 455-0380
- NPI assigned
- Aug 24, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dayspring Health Inc
Practice addresses (Care Compare)
550 Sunset TRL
Jellico, TN 37762-2343
Phone (423) 784-5771
PO Box
Jellico, TN 37762
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190325000278 | TN | Practitioner - Physician Assistant | 2769722057 | Reassigns benefits to 1 organization |
| I20210921002813 | KY | Practitioner - Physician Assistant | 2769722057 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dayspring Health Inc | Multi-Specialty | Current |
Accepting new patients |
| Dayspring Health, Inc. | Multi-Specialty | Current |
Accepting new patients |
| Dayspring Health, Inc. | Current |
Accepting new patients |
Locations
1047 S Highway 25 W
Williamsburg, KY 40769
Phone (606) 549-0449
402 Cumberland Ave
Williamsburg, KY 40769
Phone (423) 784-5771
5663 Highway 90
Clairfield, TN 37715
Phone (423) 784-5771
107 S Main St
Jellico, TN 37762
Phone (423) 784-8492
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2407 | KY | |
| Physician Assistant |
363A00000X | 3646 | TN | Yes |
Addresses
Primary practice location
550 Sunset TRL
Jellico, TN 37762-2343
Mailing address
107 S Main St
Jellico, TN 37762-2154
Phone (423) 784-5771
Other practice location 1
402 Cumberland Ave
Williamsburg, KY 40769-1238
Phone (423) 784-5771
Other practice location 2
5663 Highway 90
Clairfield, TN 37715-3632
Phone (423) 784-5771
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA2407 | Other | KY | STATE LICENSE |
| 3646 | Other | TN | STATE LICENSE |
| 7100571470 | Medicaid | KY | |
| Q045895 | Medicaid | TN |
Other providers in Jellico, TN
- Pedro Pablo Flores
- Ruchi Gupta
- Ronald Dennis Hartman
- Charles R Hayes
- HCC of Jellico LLC
- Jellico Community Hospital Inc.
- Jellico Community Hospital Inc.
- Jellico Community Hospital Inc.
- Jellico Community Hospital LLC
- Jellico Community Hospital, Inc
All providers in Jellico, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.