Healthcare Provider Details

I. General information

NPI: 1063435444
Provider Name (Legal Business Name): CASEY D STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 KELLEY HIGHWAY
FORT SMITH AR
72904-5000
US

IV. Provider business mailing address

PO BOX 130
RATCLIFF AR
72951-0130
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-5700
  • Fax: 479-785-5708
Mailing address:
  • Phone: 479-635-5300
  • Fax: 479-635-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE2074
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: