Healthcare Provider Details

I. General information

NPI: 1902293756
Provider Name (Legal Business Name): CAROLINE MARIE STUART PA-C, MPAS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE MARIE MELROSE PA-C, MPAS, ATC

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16528 E DESMET CT STE B2200
SPOKANE VALLEY WA
99216-3522
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-944-8920
  • Fax:
Mailing address:
  • Phone: 866-747-2455
  • Fax: 208-457-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA-2010
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA61116968
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2010
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61116968
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-2010
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: