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General NPI Number Information
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NPI Number | 1295466407
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Entity Type | Individual
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Provider Name | HOLLY LYNN STEWART FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/19/2022
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 4321 BETHEL CHURCH RD
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City | GIBSON
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State | GA
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Zip | 30810-4904
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Country | US
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Telephone | 706-699-1742
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Fax |
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Provider Business Mailing Address
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Address Line | 510 WASHINGTON AVE
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1971
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Country | US
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Telephone | 762-220-1199
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN258128
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN258128
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License Number State | GA
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