CRYSTAL RENEE STAFFORD (NPI# 1851816797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851816797 |
| Entity Type | Individual |
| Full Name | CRYSTAL RENEE STAFFORD |
| Credential | FNP-C |
| Practice Address |
975 Hall St Wiggins MS 39577-2107 |
| Mailing Address |
Po Box 1007 Lucedale MS 39452-1007 |
| Practice Telephone | 6015289119 |
| Mailing Telephone | 6015289119 |
| Mailing Fax Number | 6019471331 |
| Enumeration Date | 2017-08-12 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
902087 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
F06171077 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | MS MEDICAL LICENSURE | 902087 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4215 15th St, Gulfport, MS 395012523 | 2288635211 |
| Street Address |
975 HALL ST |
| City | WIGGINS |
| State | MS |
| Zip Code | 39577-2107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518906734 | Donald Robert Doran Jr. | Family Medicine | 975 Hall St, Wiggins, MS 39577-2107 | 2006-06-05 |
| 1487127031 | Tristan Diaz | Registered Nurse | 975 Hall St, Wiggins, MS 39577-2107 | 2019-01-07 |
| 1922381466 | Michelle Mcqueen Johnson | Nurse Practitioner | 975 Hall St, Wiggins, MS 39577-2107 | 2011-09-21 |
| 1346355583 | Glynnis D Randall | Nurse Practitioner | 975 Hall St, Wiggins, MS 39577-2107 | 2006-08-20 |
| 1639182124 | Deepinder S. Burn | Internal Medicine | 975 Hall St, Wiggins, MS 39577-2107 | 2006-08-14 |
| 1740293257 | Wiggins Primary Care | Family Medicine | 975 Hall St, Wiggins, MS 39577-2107 | 2006-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689057721 | John Thames | Emergency Medicine | 1428 Azalea Dr S, Wiggins, MS 39577 | 2015-07-07 |
| 1235468190 | Stone County School District | Local Education Agency (LEA) | 214 Critz Street, Wiggins, MS 39577 | 2009-12-23 |
| 1043452493 | Stone County Hospital, Inc | General Acute Care Hospital | 1434 E Central Ave., Wiggins, MS 39577 | 2009-04-01 |
| 1245274414 | James Walter Holmes | Family Medicine | 975 Hall Street, Wiggins, MS 39577 | 2006-06-16 |
| 1891223186 | Christine L Ladner | Nurse Practitioner | 1434 Central Ave E, Wiggins, MS 39577 | 2017-05-31 |
| 1790962637 | The Vision Center Pa | Optometrist | 1113 Central Ave E, Wiggins, MS 39577 | 2008-01-23 |
| 1821009465 | County Discount Drugs, Inc. | Durable Medical Equipment & Medical Supplies | 820 Hall St, Wiggins, MS 39577-2100 | 2006-08-10 |
| 1154430940 | Batson Physical Therapy, Inc. | Clinic/Center | 711 Hall St, Wiggins, MS 39577-2105 | 2006-08-29 |
| 1033723937 | Katherine B Tyree | Physical Therapist | 711 Hall St, Wiggins, MS 39577-2105 | 2020-09-08 |
| 1114569340 | Johelen K Trisler | Physical Therapy Assistant | 711 Hall St, Wiggins, MS 39577-2105 | 2019-10-09 |
| Find all providers in zip 39577 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164086716 | Charles Ray Strange IIi | Nurse Practitioner | 1130 Frontage Dr W, Wiggins, MS 39577-8165 | 2019-04-30 |
| 1548774037 | Maranda L Husley | Nurse Practitioner | 87 Sellers St, Wiggins, MS 39577-8741 | 2017-11-20 |
| 1386125383 | Kendra Iesha Samuel | Nurse Practitioner | 1434 Central Ave E, Wiggins, MS 39577-9602 | 2018-08-27 |
| 1891223186 | Christine L Ladner | Nurse Practitioner | 1434 Central Ave E, Wiggins, MS 39577 | 2017-05-31 |
| 1922381466 | Michelle Mcqueen Johnson | Nurse Practitioner | 975 Hall St, Wiggins, MS 39577-2107 | 2011-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982205423 | Ronequa Evans | Nurse Practitioner | 811 Clubhouse Dr, Pearl, MS 39208-7023 | 2020-11-02 |
| 1659971380 | Lucy M Barnes | Nurse Practitioner | 2401 State Blvd, Meridian, MS 39307-5033 | 2020-10-30 |
| 1952901076 | Angela Holloway | Nurse Practitioner | 1316 County Road 94, New Albany, MS 38652-8556 | 2020-10-28 |
| 1073113304 | Tasha Rucker | Nurse Practitioner | 2372 Us49-e, Sumner, MS 38957 | 2020-10-27 |
| 1881293371 | Hanna Fernandez | Nurse Practitioner | 14225 Dedeaux Rd, Gulfport, MS 39503-3369 | 2020-10-26 |
| 1285233452 | Darlene Johnson | Nurse Practitioner | 2808 Allyson Gene Cv, Byhalia, MS 38611-7359 | 2020-10-20 |
| 1447857073 | Clarissa Nicole Yarborough | Nurse Practitioner | 113 Saint John Rd, Tylertown, MS 39667-7927 | 2020-10-06 |
| 1922615616 | Jack Chandler Papa | Nurse Practitioner | 3556 May Brook Cv, Southaven, MS 38672-1006 | 2020-09-26 |
| 1205443165 | Mallory Stockstill | Nurse Practitioner | 27 Tillery Pl, Ellisville, MS 39437-4784 | 2020-09-24 |
| 1184230898 | Evelyn Michelle Rainey | Nurse Practitioner | 271 Eskridge Road, Duck Hill, MS 38925 | 2020-09-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.