| Doctor Name: | DR. NINA NICOLE JEFFERSON |
| NPI Number: | 1881912137 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | PSY003323 |
| Business Practice Address: | 300 South School Street Dermott, AR - 71638 |
| Business Phone Number: | 8705383355 |
| Business Fax Number: | 8705383701 |
| Mailing Address: | Po Box 509, DERMOTT |
| State: | AR |
| Postal Code: | 71638 |
| Phone Number: | 8705385414 |
| Fax Number: | 8705385412 |
| NPI Enumeration Date: | 05/12/2010 |
| NPI Last Update Date: | 02/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY003323 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |