Provider Demographics
NPI:1912172073
Name:STEWARD, KATHLEEN SUSAN (CHP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:STEWARD
Suffix:
Gender:F
Credentials:CHP
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 2088
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-2088
Mailing Address - Country:US
Mailing Address - Phone:907-224-4908
Mailing Address - Fax:907-224-5870
Practice Address - Street 1:201 THIRD AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664
Practice Address - Country:US
Practice Address - Phone:907-224-3490
Practice Address - Fax:907-224-5870
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDH0196Medicaid