Provider Demographics
NPI:1073002408
Name:STEWART, KIMBERLY NICOLE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 HIGHWAY 69 S
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-8797
Mailing Address - Country:US
Mailing Address - Phone:205-732-7375
Mailing Address - Fax:
Practice Address - Street 1:9070 HIGHWAY 69 S
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-8797
Practice Address - Country:US
Practice Address - Phone:205-722-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107152363LF0000X
AL2016021790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily