Healthcare Provider Details

I. General information

NPI: 1083070593
Provider Name (Legal Business Name): CAROL LEE STEWART DNP, APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 3RD STREET SW
WAGNER SD
57380
US

IV. Provider business mailing address

PO BOX 280
WAGNER SD
57380-0280
US

V. Phone/Fax

Practice location:
  • Phone: 605-384-3611
  • Fax:
Mailing address:
  • Phone: 605-384-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001024
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200881
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4925
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: