MEDICARE: MR. STACEY RAYFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	1584827	LA
2	376K00000X	Nurse's Aide	1584894	LA
3	376K00000X	Nurse's Aide	1456462	LA

General Provider Information

NPI Number	:	1336271329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STACEY RAYFORD

Provider Business Mailing Address
First Line	:	11628 S CHOCTAW DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-2107
Country	:	US
Telephone Number	:	225-275-5999
Fax Number	:	225-275-6611

Provider Business Practice Location Address
First Line	:	11628 S CHOCTAW DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-2107
Country	:	US
Telephone Number	:	225-275-5999
Fax Number	:	225-275-6611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. STACEY RAYFORD ” Practice Location

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