Healthcare Provider Details

I. General information

NPI: 1720750482
Provider Name (Legal Business Name): KAY STEWART ACNPC-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W GRAND AVE STE 2002
DAYTON OH
45405-4722
US

IV. Provider business mailing address

2400 MIAMI VALLEY DR
CENTERVILLE OH
45459-4774
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-3611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0029377
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029377
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: