Provider Demographics
NPI:1497987937
Name:STEWART, KATHRYN E (LMT, RCST)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMT, RCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2815
Mailing Address - Country:US
Mailing Address - Phone:859-552-7267
Mailing Address - Fax:859-276-0224
Practice Address - Street 1:2816 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2815
Practice Address - Country:US
Practice Address - Phone:859-552-7267
Practice Address - Fax:859-276-0224
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
KY0271225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula