Provider Demographics
NPI:1104229301
Name:STEWART, FARRAH ALECIA (RN)
Entity type:Individual
Prefix:MRS
First Name:FARRAH
Middle Name:ALECIA
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:FARRAH
Other - Middle Name:ALECIA
Other - Last Name:STEWART-TARVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:7622 THEISSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4639
Mailing Address - Country:US
Mailing Address - Phone:281-944-8042
Mailing Address - Fax:
Practice Address - Street 1:7622 THEISSWOOD RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4639
Practice Address - Country:US
Practice Address - Phone:281-944-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX787076163W00000X, 163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health