MEDICARE: MS. CAROLINE MARIE STUART PA-C, MPAS, ATC

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	363AS0400X	Surgical Physician Assistant	PA-2010	ID
2	363AS0400X	Surgical Physician Assistant	PA61116968	WA
3	363A00000X	Physician Assistant	PA-2010	ID
4	363A00000X	Physician Assistant	PA61116968	WA
5	363AM0700X	Medical Physician Assistant	PA-2010	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902293756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLINE MARIE STUART PA-C, MPAS, ATC

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0421
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:	208-457-4197

Provider Business Practice Location Address
First Line	:	16528 E DESMET CT STE B2200
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-3522
Country	:	US
Telephone Number	:	509-944-8920
Fax Number	:

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

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	06/03/2026

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