Provider Demographics
NPI:1457540338
Name:STEWART, JULIE BERENDA (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:BERENDA
Last Name:STEWART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W SLAUGHTER LN STE A-130155
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-6527
Mailing Address - Country:US
Mailing Address - Phone:254-631-0111
Mailing Address - Fax:254-631-0186
Practice Address - Street 1:711 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2534
Practice Address - Country:US
Practice Address - Phone:254-631-0111
Practice Address - Fax:254-631-0186
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily