Provider Demographics
NPI:1225729122
Name:STEWART, CANDICE M
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:BRINKLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72021-2057
Mailing Address - Country:US
Mailing Address - Phone:870-734-3202
Mailing Address - Fax:
Practice Address - Street 1:490 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-2057
Practice Address - Country:US
Practice Address - Phone:870-734-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator