Provider Demographics
NPI:1689988743
Name:STEWART, PAMELA KAY (MS, NP-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LENNOX
Mailing Address - State:SD
Mailing Address - Zip Code:57039-2096
Mailing Address - Country:US
Mailing Address - Phone:605-647-2841
Mailing Address - Fax:605-647-2843
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LENNOX
Practice Address - State:SD
Practice Address - Zip Code:57039-2096
Practice Address - Country:US
Practice Address - Phone:605-647-2841
Practice Address - Fax:605-647-2843
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-01
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily