Provider Demographics
NPI:1891197323
Name:STEWART, RACHELLE LYLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:LYLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PETERS COURT
Mailing Address - Street 2:
Mailing Address - City:COOL RIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25825
Mailing Address - Country:US
Mailing Address - Phone:304-923-4409
Mailing Address - Fax:
Practice Address - Street 1:1500 TERRACE ST STE 105
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-9768
Practice Address - Country:US
Practice Address - Phone:304-466-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01842363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical