Provider Demographics
NPI:1689084154
Name:STAFFORD, CAYLEY MARANDA (QBHP)
Entity Type:Individual
Prefix:MS
First Name:CAYLEY
Middle Name:MARANDA
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:CAYLEY
Other - Middle Name:MARANDA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QBHP
Mailing Address - Street 1:1815 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:1507 E. RACE STREET
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4661
Practice Address - Country:US
Practice Address - Phone:501-305-2359
Practice Address - Fax:501-305-2348
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator