Individual
MS. KRISTEN REGINA STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-7001
(859) 257-1000
Mailing address
101 S HANOVER AVE APT 5K, LEXINGTON, KY 40502-1879
(845) 742-4844
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001275914
VA
163W00000X
Registered Nurse
612460
NY
367500000X
Certified Registered Nurse Anesthetist
0024175448
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
3012083
KY
367500000X
Certified Registered Nurse Anesthetist
612460
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3012083
STATE LICENSE
KY
05
—
7100539760
—
KY
01
—
K174864
MEDICARE
KY
Enumeration date
07/22/2014
Last updated
07/25/2019
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