Individual
MRS. BEVERLY FULGHAM STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1500 E WOODROW WILSON, JACKSON, MS 39216
(601) 362-4471
(601) 368-4479
Mailing address
104 TRACIER CRST, CLINTON, MS 39056-6236
(601) 924-7732
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R734107
MS
Other
Enumeration date
10/04/2006
Last updated
01/22/2008
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