Provider Demographics
NPI:1053134056
Name:JEFFERSON, DEMETRIA YUSHONE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:YUSHONE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 S LOOP W STE 525
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2691
Mailing Address - Country:US
Mailing Address - Phone:832-378-8282
Mailing Address - Fax:832-834-6002
Practice Address - Street 1:2626 S LOOP W STE 525
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2691
Practice Address - Country:US
Practice Address - Phone:832-378-8282
Practice Address - Fax:832-834-6002
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179604363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health