Provider Demographics
NPI:1043995319
Name:STAFFORD, KIRA
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
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 1:9802 NICHOLAS ST STE 395
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2168
Mailing Address - Country:US
Mailing Address - Phone:732-806-0091
Mailing Address - Fax:
Practice Address - Street 1:9802 NICHOLAS ST STE 395
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2168
Practice Address - Country:US
Practice Address - Phone:732-806-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician