Provider Demographics
NPI:1164803581
Name:STUART, DESIREE (PA-C)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2216 E 32ND ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3016
Mailing Address - Country:US
Mailing Address - Phone:417-624-8730
Mailing Address - Fax:417-624-8747
Practice Address - Street 1:2216 E 32ND ST
Practice Address - Street 2:SUITE #101
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3016
Practice Address - Country:US
Practice Address - Phone:417-624-8730
Practice Address - Fax:417-624-8747
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015017424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant