Provider Demographics
NPI:1558828574
Name:STEWART, KAPRICE DOMINIQUE
Entity Type:Individual
Prefix:
First Name:KAPRICE
Middle Name:DOMINIQUE
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 1:5810 CHATFORD DR APT F
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3180
Mailing Address - Country:US
Mailing Address - Phone:614-284-8418
Mailing Address - Fax:
Practice Address - Street 1:2540 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1990
Practice Address - Country:US
Practice Address - Phone:614-602-6473
Practice Address - Fax:614-602-6493
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator