Provider Demographics
NPI:1124450176
Name:STAFFORD, PATRICIA KAY (CRNP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KAY
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LONACONING
Mailing Address - State:MD
Mailing Address - Zip Code:21539-2143
Mailing Address - Country:US
Mailing Address - Phone:301-471-6462
Mailing Address - Fax:
Practice Address - Street 1:215 HERITAGE CT
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-9159
Practice Address - Country:US
Practice Address - Phone:301-845-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122920363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner