Healthcare Provider Details

I. General information

NPI: 1689470098
Provider Name (Legal Business Name): GREGORY DON STEWART JR. APSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10443 W MANSLICK RD
FAIRDALE KY
40118-9563
US

IV. Provider business mailing address

10443 W MANSLICK RD
FAIRDALE KY
40118-9563
US

V. Phone/Fax

Practice location:
  • Phone: 502-804-6835
  • Fax:
Mailing address:
  • Phone: 502-804-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: