Provider Demographics
NPI:1124375118
Name:STEWART, KRISTINA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 W SECOND ST
Mailing Address - Street 2:#159
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-5553
Mailing Address - Country:US
Mailing Address - Phone:228-206-7200
Mailing Address - Fax:
Practice Address - Street 1:2012 W 2ND ST
Practice Address - Street 2:#159
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-5553
Practice Address - Country:US
Practice Address - Phone:228-206-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP326390164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse