Provider Demographics
NPI:1679058341
Name:BUFORD, STACY (LPN, LVN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BUFORD
Suffix:
Gender:F
Credentials:LPN, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23372 ROPERS RD
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-9566
Mailing Address - Country:US
Mailing Address - Phone:580-677-2762
Mailing Address - Fax:
Practice Address - Street 1:23372 ROPERS RD
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-9566
Practice Address - Country:US
Practice Address - Phone:580-677-2762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0042316164W00000X
TX185241164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse