Healthcare Provider Details

I. General information

NPI: 1124580097
Provider Name (Legal Business Name): KIM CRAWFORD STEWART DO, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MCDOWELL ST
ASHEVILLE NC
28801-4434
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 828-258-8800
  • Fax:
Mailing address:
  • Phone: 828-258-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2024-02855
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: