Provider Demographics
NPI:1679667901
Name:STEWART, JUDY (ARNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:STEWART
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0190
Mailing Address - Country:US
Mailing Address - Phone:509-575-1234
Mailing Address - Fax:509-575-3320
Practice Address - Street 1:2205 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2437
Practice Address - Country:US
Practice Address - Phone:590-575-1234
Practice Address - Fax:509-575-3320
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005997367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9631409Medicaid
911019392OtherCOMMERCIAL
WA150953OtherL & I
23111OtherGROUP HEALTH
WA3890STOtherREGENCE
WA9631409OtherCHPW
23111OtherGROUP HEALTH
911019392OtherCOMMERCIAL