| Doctor Name: | JACKIE STAFFORD |
| NPI Number: | 1609150622 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 41895 |
| Business Practice Address: | 212 3rd St Cheraw, SC - 295202648 |
| Business Phone Number: | 8435370961 |
| Business Fax Number: | 8435370908 |
| Mailing Address: | 201 S 5th St, HARTSVILLE |
| State: | SC |
| Postal Code: | 295504211 |
| Phone Number: | 8438570111 |
| Fax Number: | |
| NPI Enumeration Date: | 10/10/2011 |
| NPI Last Update Date: | 10/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 41895 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |