Provider Demographics
NPI:1932276417
Name:STEWART, KRISTINA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 N VERCLER RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1092
Mailing Address - Country:US
Mailing Address - Phone:509-924-4681
Mailing Address - Fax:509-922-7634
Practice Address - Street 1:1414 N VERCLER RD STE 4
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1092
Practice Address - Country:US
Practice Address - Phone:509-924-4681
Practice Address - Fax:509-922-7634
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60041683363A00000X, 363A00000X
WAOA60790137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA246224OtherL&I
WA246224OtherL&I