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Individual
MRS. KELLY L. STAFFORD
Active
Individual
MRS. KELLY L. STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-02443
NC
363AS0400X
Surgical Physician Assistant
MA051965
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA051965
MEDICAL PHYSICIAN ASST
PA
01
—
PA05336
TEXAS STATE LICENSE #
TX
Enumeration date
08/12/2005
Last updated
03/21/2011
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