Individual
JACKIE P. STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
710 CHESTERFIELD HWY, CHERAW, SC 29520-7001
(843) 537-2171
(843) 537-5926
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 777-7098
(843) 777-7102
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
17625
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP1947
—
SC
Enumeration date
10/10/2011
Last updated
02/22/2021
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