Provider Demographics
NPI:1003522707
Name:STAFFORD, ABIGAIL LEE
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LEE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 IRON LOOP PATH
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8108
Mailing Address - Country:US
Mailing Address - Phone:606-422-9887
Mailing Address - Fax:
Practice Address - Street 1:2203 IRON LOOP PATH
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8108
Practice Address - Country:US
Practice Address - Phone:606-422-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program