Healthcare Provider Details

I. General information

NPI: 1336075019
Provider Name (Legal Business Name): AUDRIANNA STAFFORD WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 COUNTRY CLUB RD
LUMBERTON NC
28360-9494
US

IV. Provider business mailing address

3914 NEWGATE ST
FAYETTEVILLE NC
28306-7485
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSTAF-USLMW
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: