MEDICARE: KELCIE STEWART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1831946201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELCIE STEWART

Provider Business Mailing Address
First Line	:	6752 W GULF TO LAKE HWY # 104
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-9348
Country	:	US
Telephone Number	:	316-749-3459
Fax Number	:

Provider Business Practice Location Address
First Line	:	6752 W GULF TO LAKE HWY # 104
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-9348
Country	:	US
Telephone Number	:	316-749-3459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2024
Last Update Date	:	05/03/2024

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Directions to “ KELCIE STEWART ” Practice Location

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