Provider Demographics
NPI:1043606908
Name:STEWART, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17515 SPRING CYPRESS RD
Mailing Address - Street 2:SUITE C, #351
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2688
Mailing Address - Country:US
Mailing Address - Phone:281-210-7624
Mailing Address - Fax:
Practice Address - Street 1:16007 HILTON HEAD LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6324
Practice Address - Country:US
Practice Address - Phone:281-210-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801787116343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)