Provider Demographics
NPI:1043811086
Name:STUART, PATRICIA WILSON (CDCES)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:WILSON
Last Name:STUART
Suffix:
Gender:F
Credentials:CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 PECAN ESTATES CV
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-7371
Mailing Address - Country:US
Mailing Address - Phone:601-415-0705
Mailing Address - Fax:
Practice Address - Street 1:3414 PECAN ESTATES CV
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-7371
Practice Address - Country:US
Practice Address - Phone:601-415-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No172V00000XOther Service ProvidersCommunity Health Worker
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist