Provider Demographics
NPI:1700915980
Name:STEWART, ANGELA (MED)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:714 E EVERLY BROTHERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:714 E EVERLY BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1714
Practice Address - Country:US
Practice Address - Phone:270-543-4622
Practice Address - Fax:270-754-9498
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist