Provider Demographics
NPI:1962497610
Name:STAFFORD, KRISTI ANN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:ANN
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:A
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:514 W WINDCREST ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4633
Mailing Address - Country:US
Mailing Address - Phone:830-997-0330
Mailing Address - Fax:830-997-7601
Practice Address - Street 1:514 W WINDCREST ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4633
Practice Address - Country:US
Practice Address - Phone:830-997-0330
Practice Address - Fax:830-997-7601
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112004004Medicaid
TX8AQ213OtherBCBSTX
TXP00454187OtherMEDICARE RAILROAD
TX112004004Medicaid
TXP00454187OtherMEDICARE RAILROAD