Healthcare Provider Details

I. General information

NPI: 1245166529
Provider Name (Legal Business Name): CHANDRA CHARLITA STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 COURT ST
PORT ALLEN LA
70767-2747
US

IV. Provider business mailing address

600 WOODDALE BLVD APT 221
BATON ROUGE LA
70806-2979
US

V. Phone/Fax

Practice location:
  • Phone: 225-401-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: