Provider Demographics
NPI:1619406162
Name:STEWART, AMANDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 FM 1960 BYPASS RD E STE 122
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3934
Mailing Address - Country:US
Mailing Address - Phone:832-781-4340
Mailing Address - Fax:
Practice Address - Street 1:1420 FM 1960 BYPASS RD E STE 122
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3934
Practice Address - Country:US
Practice Address - Phone:832-781-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine