Healthcare Provider Details

I. General information

NPI: 1184551319
Provider Name (Legal Business Name): MRS. KRISTEN ELISABETH STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S MAIN ST
BOILING SPRINGS NC
28017-9797
US

IV. Provider business mailing address

618 GOBLE RD
HIDDENITE NC
28636-9244
US

V. Phone/Fax

Practice location:
  • Phone: 704-406-4000
  • Fax:
Mailing address:
  • Phone: 704-949-9044
  • Fax: 704-949-9044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: