Healthcare Provider Details

I. General information

NPI: 1003737511
Provider Name (Legal Business Name): MAISIE STEWART
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 TETRICK RD APT 101
SHINNSTON WV
26431-7004
US

IV. Provider business mailing address

615 TETRICK RD APT 101
SHINNSTON WV
26431-7004
US

V. Phone/Fax

Practice location:
  • Phone: 304-566-2072
  • Fax:
Mailing address:
  • Phone: 304-566-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: