Provider Demographics
NPI:1457483786
Name:STEWARD, PEGGY ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:STEWARD
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 1:8121 W QUINAULT AVE STE F101
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8210
Mailing Address - Country:US
Mailing Address - Phone:509-438-8966
Mailing Address - Fax:949-404-8805
Practice Address - Street 1:8121 W QUINAULT AVE STE F101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8210
Practice Address - Country:US
Practice Address - Phone:509-438-8966
Practice Address - Fax:949-404-8805
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007625363LF0000X
HIAPRN-996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9655838Medicaid
WA0230416OtherLABOR & INDUSTRIES
WA9655838Medicaid