Provider Demographics
NPI:1740800812
Name:SMITH-STEWART, KEENA
Entity Type:Individual
Prefix:
First Name:KEENA
Middle Name:
Last Name:SMITH-STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8341
Mailing Address - Country:US
Mailing Address - Phone:803-572-0302
Mailing Address - Fax:
Practice Address - Street 1:1864 WILDWOOD LN
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8341
Practice Address - Country:US
Practice Address - Phone:803-572-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health