| Provider / Organization | NPI | Date Certified |
|---|---|---|
| AMY WHITE STAFFORD | 1386845964 | 2024-01-06 |
Amy White Stafford is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1386845964. Registration indicates Amy White Stafford is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| Entity Type | Individual |
| Provider Name | Amy White Stafford PA-C |
| Practice Office Address | 9007 ELLERBE RD SHREVEPORT, LA US |
| Practice Office Telephone | 3182223278 |
| Practice Office Fax | 3184243155 |
| Mailing Address | 9007 ELLERBE RD SHREVEPORT, LA 711066724 US |
| Business Telephone | 3182223278 |
| Business Fax | 3184243155 |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | PA.A10510
LA |
| 1529044 | MEDICAID | LA |