Provider Demographics
NPI:1295026268
Name:STEWART, JENNIFER T (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:T
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP
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 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-832-4699
Mailing Address - Fax:228-831-5606
Practice Address - Street 1:20006 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-7843
Practice Address - Country:US
Practice Address - Phone:228-832-4699
Practice Address - Fax:228-831-5606
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily