Healthcare Provider Details

I. General information

NPI: 1699315192
Provider Name (Legal Business Name): PAUL STEWART FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E STATE HIGHWAY 243 STE 18
CANTON TX
75103-2445
US

IV. Provider business mailing address

PO BOX 1610
ATHENS TX
75751-1610
US

V. Phone/Fax

Practice location:
  • Phone: 903-287-5011
  • Fax: 903-287-5017
Mailing address:
  • Phone: 903-603-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1044093
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: