Provider Demographics
NPI:1508194523
Name:STEWART, KATHY MALONE (CPNP-0024059516)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:MALONE
Last Name:STEWART
Suffix:
Gender:F
Credentials:CPNP-0024059516
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5855 BREMO RD
Mailing Address - Street 2:MOB NORTH SUITE #302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1923
Mailing Address - Country:US
Mailing Address - Phone:804-282-4207
Mailing Address - Fax:804-285-5958
Practice Address - Street 1:5855 BREMO RD
Practice Address - Street 2:MOB NORTH SUITE #302
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1923
Practice Address - Country:US
Practice Address - Phone:804-282-4207
Practice Address - Fax:804-285-5958
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024059516363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics