Provider Demographics
NPI:1336271329
Name:RAYFORD, STACEY
Entity Type:Individual
Prefix:MR
First Name:STACEY
Middle Name:
Last Name:RAYFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11628 S CHOCTAW DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-2107
Mailing Address - Country:US
Mailing Address - Phone:225-275-5999
Mailing Address - Fax:225-275-6611
Practice Address - Street 1:11628 S CHOCTAW DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2107
Practice Address - Country:US
Practice Address - Phone:225-275-5999
Practice Address - Fax:225-275-6611
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1584827376K00000X
LA1584894376K00000X
LA1456462376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide