Provider Demographics
NPI:1275017493
Name:STEWART, TRACY YOLANDA
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:YOLANDA
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 1:835 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-8517
Mailing Address - Country:US
Mailing Address - Phone:251-406-9355
Mailing Address - Fax:
Practice Address - Street 1:835 HUNTERS LN
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-8517
Practice Address - Country:US
Practice Address - Phone:251-406-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)