Katherine Jeanne Stafford, NP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

489727 Issued in CA

Practice address

34952 Gail Ave
Yucaipa, CA 92399-2830

Phone

(909) 917-5504

NPI assigned

Aug 19, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1417569526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34952 GAIL AVE",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923992830",
            "telephone_number": "909-917-5504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34952 GAIL AVE",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923992830",
            "telephone_number": "909-917-5504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "KATHERINE",
        "middle_name": "JEANNE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "489727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern California Hospice Care
• Dionne Southworth, M.A., ED. S.
• Jordan Keith Spady, DPT
• Doreen Spearman, PT
• John Sricharoon
• Caitlin C Stanley
• Tigran Stepanyan, D.O.
• Stepien Seheult Consulting Inc
• Evan Paul Sternard
• Steven a. Miller, O.D.

• Women's Health Nurse Practitioner in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Women's Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.