Healthcare Provider Details

I. General information

NPI: 1700432846
Provider Name (Legal Business Name): HEATHER STEWART NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S FREMONT AVE STE 3300
SPRINGFIELD MO
65804-2246
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-5200
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019021275
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: