Kelsey Marie Jeffries

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

263498 Issued in AZ

Practice address

306 W Aero Dr
Payson, AZ 85541-5405

Phone

(928) 466-4242

NPI assigned

Sep 22, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Addiction Wellness Center Ok LLC

  • Community/Behavioral Health Agency
  • Oklahoma City, OK
  • NPI 1124719596

  Nurse Practitioner

  Medicare reassignment NPD
• Mogollon Treatment Center

  dba Mogollon Residential

  • Substance Abuse Rehabilitation Facility
  • Payson, AZ
  • NPI 1063225233
  NPD (past)

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

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1639840382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896",
            "city": "WARNER",
            "state": "OK",
            "postal_code": "744690896",
            "telephone_number": "520-709-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 W AERO DR",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415405",
            "telephone_number": "928-466-4242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2236 Highway 412",
            "address_purpose": "LOCATION",
            "city": "West Siloam Springs",
            "state": "OK",
            "postal_code": "743381308",
            "country_code": "US",
            "telephone_number": "918-422-5750",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 E Memorial Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731311827",
            "country_code": "US",
            "telephone_number": "405-446-5714",
            "fax_number": "405-497-6155",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Woodland Hills Blvd",
            "address_purpose": "LOCATION",
            "city": "Roland",
            "state": "OK",
            "postal_code": "749545213",
            "country_code": "US",
            "telephone_number": "918-503-6464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFFRIES",
        "first_name": "KELSEY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-22",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "263498",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "209578",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20112620A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ideal Therapies, PLLC
• Ivan D. McLaws, DPM
• Jaber Abawi MD Inc
• Mary Jackson, LPC-22257
• Loran C Jacobs Jr., CRNA
• Eldon W Jenkins
• John Bravo Dacanay MD PC
• Benjamin Patrick Johnson, MD
• Hudson S Johnston, DMD, MS
• Jason Lee Kang, M.D.

• Family Nurse Practitioner in Payson, AZ
• Providers in Payson, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; 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.