Provider Demographics
NPI:1861509101
Name:STEWART, KYLE LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:LESLIE
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2440
Mailing Address - Country:US
Mailing Address - Phone:918-335-1616
Mailing Address - Fax:918-335-1617
Practice Address - Street 1:3400 E FRANK PHILLIPS BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2440
Practice Address - Country:US
Practice Address - Phone:918-335-1616
Practice Address - Fax:918-335-1617
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK119252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100198620BOtherMEDICAID
OK100151970AMedicaid
OKD35314Medicare UPIN