Healthcare Provider Details

I. General information

NPI: 1922319102
Provider Name (Legal Business Name): CAROL STEWART NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 EAST DR 102 MOORE HALL
MONTGOMERY AL
36117
US

IV. Provider business mailing address

PO BOX 11087
MONTGOMERY AL
36111-0087
US

V. Phone/Fax

Practice location:
  • Phone: 334-244-3281
  • Fax: 334-244-3396
Mailing address:
  • Phone: 334-481-1599
  • Fax: 334-356-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-045437
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: