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General NPI Number Information
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NPI Number | 1245191253
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Entity Type | Individual
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Provider Name | KALEY ANN STEWART MMS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 7786 S CICERO AVE
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City | BURBANK
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State | IL
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Zip | 60459-1583
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Country | US
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Telephone | 708-425-3085
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Fax |
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Provider Business Mailing Address
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Address Line | 416 BLACKSTONE AVE
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City | WILLOW SPRINGS
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State | IL
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Zip | 60480-1507
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Country | US
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Telephone | 708-969-2964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.011683
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License Number State | IL
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