Provider Demographics
NPI:1215480637
Name:STEWART, KATHERINE M (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2130 CITRACADO PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4149
Mailing Address - Country:US
Mailing Address - Phone:760-743-4789
Mailing Address - Fax:760-743-4779
Practice Address - Street 1:2130 CITRACADO PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4149
Practice Address - Country:US
Practice Address - Phone:760-743-4789
Practice Address - Fax:623-873-8565
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63066363A00000X
AZ6456363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical