Provider Demographics
NPI:1235196254
Name:STEWART, SKIPPER K (APRN)
Entity Type:Individual
Prefix:MR
First Name:SKIPPER
Middle Name:K
Last Name:STEWART
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1573
Mailing Address - Street 2:21098 OAK ALLEY DRIVE
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754-6310
Mailing Address - Country:US
Mailing Address - Phone:225-686-1244
Mailing Address - Fax:
Practice Address - Street 1:14292 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754
Practice Address - Country:US
Practice Address - Phone:225-686-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1332615Medicaid
LA1332615Medicaid