Healthcare Provider Details

I. General information

NPI: 1396344685
Provider Name (Legal Business Name): KAMBRE A STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E BAYOU RD
THIBODAUX LA
70301-8036
US

IV. Provider business mailing address

320 PROGRESSIVE BLVD
HOUMA LA
70360-4069
US

V. Phone/Fax

Practice location:
  • Phone: 985-879-3966
  • Fax:
Mailing address:
  • Phone: 985-303-6090
  • 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: