Healthcare Provider Details

I. General information

NPI: 1841392651
Provider Name (Legal Business Name): JANIECE N STEWART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 LACLEDE AVE
SAINT LOUIS MO
63108-2814
US

IV. Provider business mailing address

4255 LACLEDE AVE STE A
SAINT LOUIS MO
63108-2814
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-0060
  • Fax: 314-912-0208
Mailing address:
  • Phone: 314-257-0060
  • Fax: 314-912-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number2019014134
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: