Provider Demographics
NPI:1902180979
Name:STEWART, MARY S (GNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:STEWART
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10026 LIZELIA RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-9595
Mailing Address - Country:US
Mailing Address - Phone:601-866-7723
Mailing Address - Fax:601-866-7773
Practice Address - Street 1:3701 8TH ST STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-6083
Practice Address - Country:US
Practice Address - Phone:601-286-3395
Practice Address - Fax:601-286-3245
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR862927363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology