Provider Demographics
NPI:1376214908
Name:STAFFORD, WILLIAM (AGACNP)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 MILLER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3556
Mailing Address - Country:US
Mailing Address - Phone:865-643-3647
Mailing Address - Fax:
Practice Address - Street 1:10820 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1956
Practice Address - Country:US
Practice Address - Phone:865-218-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30381363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care