Provider Demographics
NPI:1679060198
Name:STUART, KATHERINE LOIS (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LOIS
Last Name:STUART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6742
Mailing Address - Country:US
Mailing Address - Phone:850-863-8169
Mailing Address - Fax:850-863-7045
Practice Address - Street 1:1106 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8169
Practice Address - Fax:850-863-7045
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287388363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024732100Medicaid