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General NPI Number Information
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NPI Number | 1497444830
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Entity Type | Individual
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Provider Name | KEYAUNTA STEWART
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Gender | Female
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 3018 OLD MINDEN RD STE 1117
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City | BOSSIER CITY
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State | LA
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Zip | 71112-2497
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Country | US
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Telephone | 318-746-1935
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Fax |
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Provider Business Mailing Address
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Address Line | 5805 PAMPUS LN
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City | BOSSIER CITY
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State | LA
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Zip | 71112-4983
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 18228
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License Number State | LA
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