Provider Demographics
NPI:1124013800
Name:STEWART, DONALD KENNETH (CRNA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:KENNETH
Last Name:STEWART
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 HIGH POINTE DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8819
Mailing Address - Country:US
Mailing Address - Phone:270-554-5725
Mailing Address - Fax:270-442-1001
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-442-1024
Practice Address - Fax:270-442-1001
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74240185Medicaid
KY00000035277OtherKY BCBS
KYP00158032OtherRR MEDICARE
WV2605018000Medicaid
KY3366247Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WV2605018000Medicaid
KY74240185Medicaid
KYP00158032OtherRR MEDICARE