=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093680860
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE ELIZABETH STEWART CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2025
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 BARRETT BLVD STE 200
-----------------------------------------------------
City | EPHRATA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17522-8979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-738-5648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4150 BARRETT BLVD STE 200
-----------------------------------------------------
City | EPHRATA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17522-8979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-738-5648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP033770
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------