Provider Demographics
NPI:1003924978
Name:STEWART, JESSICA TURNER (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:TURNER
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 2ND ST UNIT 202
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3206
Mailing Address - Country:US
Mailing Address - Phone:985-640-3717
Mailing Address - Fax:
Practice Address - Street 1:1346 LINDBERG DR
Practice Address - Street 2:SUITE 7
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-646-1580
Practice Address - Fax:985-646-1579
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98533208000000X
LA026236208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA1500OtherMEDICARE PTAN
LA1052302Medicaid
FL278004600Medicaid