Provider Demographics
NPI:1821664871
Name:STEWART, LESLIE JAMISON (MSN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:JAMISON
Last Name:STEWART
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876B HOWARD AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1703
Mailing Address - Country:US
Mailing Address - Phone:731-225-8472
Mailing Address - Fax:
Practice Address - Street 1:2876B HOWARD AVE UNIT A
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1703
Practice Address - Country:US
Practice Address - Phone:765-969-3938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24926363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner