Provider Demographics
NPI:1831946201
Name:STEWART, KELCIE
Entity type:Individual
Prefix:
First Name:KELCIE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6752 W GULF TO LAKE HWY # 104
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-9348
Mailing Address - Country:US
Mailing Address - Phone:316-749-3459
Mailing Address - Fax:
Practice Address - Street 1:6752 W GULF TO LAKE HWY # 104
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-9348
Practice Address - Country:US
Practice Address - Phone:316-749-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency