Individual
CRYSTAL RENEE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
975 HALL ST, WIGGINS, MS 39577-2107
(601) 528-9119
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 528-9119
(601) 947-1331
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902087
MS
363LF0000X
Family Nurse Practitioner
F06171077
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
902087
MS MEDICAL LICENSURE
MS
Enumeration date
08/12/2017
Last updated
03/17/2018
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