Healthcare Provider Details

I. General information

NPI: 1780351676
Provider Name (Legal Business Name): PAUL STEWART
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TRAE STEWART

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MULDOWNEY LN
LAS VEGAS NV
89138-1575
US

IV. Provider business mailing address

221 MULDOWNEY LN
LAS VEGAS NV
89138-1575
US

V. Phone/Fax

Practice location:
  • Phone: 888-315-8723
  • Fax:
Mailing address:
  • Phone: 888-315-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number867523
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.61340801-NP
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202200812NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: