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General NPI Number Information
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NPI Number | 1346725090
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Entity Type | Individual
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Provider Name | NICKIE DIANE STEWART
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Gender | Female
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 6205 43RD ST
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City | LUBBOCK
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State | TX
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Zip | 79407-3828
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Country | US
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Telephone | 806-749-2263
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Fax | 806-749-2264
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Provider Business Mailing Address
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Address Line | 5219 CITY BANK PKWY STE 35
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City | LUBBOCK
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State | TX
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Zip | 79407-3545
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Country | US
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Telephone | 806-761-0334
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Fax | 806-785-0872
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP138166
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License Number State | TX
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