Provider Demographics
NPI:1841543923
Name:STEWART, LAURA ANN (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:700 KIMBER LANE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2803
Practice Address - Country:US
Practice Address - Phone:812-476-7111
Practice Address - Fax:812-476-7117
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019423363LF0000X
KY3008585363LF0000X
IN71004212A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid
000001013322OtherANTHEM PIN
9741978OtherAETNA PROVIDER ID NUMBER
KY7100525100Medicaid
IN201122250Medicaid
INP01613654OtherRAILROAD MEDICARE
KY1539357OtherWELLCARE MEDICARE OF KENTUCKY PROVIDER ID NUMBER
CS1806800260OtherCARESOURCE ID
ILP02272271OtherRAILROAD MEDICARE
KYP02182197OtherRAILROAD MEDICARE
KYPDZ000000076282OtherAETNA BETTER HEALTH OF KENTUCKY PROVIDER ID NUMBER