MEDICARE: AMANDA CAROL STEWART DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R222428	MD
2	363LF0000X	Family Nurse Practitioner	0024187683	VA

General Provider Information

NPI Number	:	1275227118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CAROL STEWART DNP

Provider Business Mailing Address
First Line	:	10412 WASHINGTON HWY STE 3
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-1918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10412 WASHINGTON HWY STE 3
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-1918
Country	:	US
Telephone Number	:	888-830-6538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	09/03/2025

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