Healthcare Provider Details

I. General information

NPI: 1679751960
Provider Name (Legal Business Name): STEPHEN LLOYD STEWART PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S WHITEHEAD DR
DE WITT AR
72042-2911
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-0300
  • Fax: 870-946-0303
Mailing address:
  • Phone: 870-946-0300
  • Fax: 870-946-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-297
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: