Healthcare Provider Details

I. General information

NPI: 1184102006
Provider Name (Legal Business Name): KATHLEEN STEWART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 CAPITAL CIR NE BLDG G
TALLAHASSEE FL
32308-4106
US

IV. Provider business mailing address

913 FRANKIE LANE DR
TALLAHASSEE FL
32310-1121
US

V. Phone/Fax

Practice location:
  • Phone: 850-523-3468
  • Fax: 850-523-3344
Mailing address:
  • Phone: 850-294-5791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number9275178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: