Provider Demographics
NPI:1578794483
Name:STUART, WALTER H IV (CRNA)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:H
Last Name:STUART
Suffix:IV
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-682-6828
Mailing Address - Fax:901-682-9316
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-682-6828
Practice Address - Fax:901-682-9316
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122581367500000X
MS810575367500000X
TN14478367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered