Provider Demographics
NPI:1215525050
Name:STEWART, KIMBERLY ANN
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 PINEY WOODS RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-3608
Mailing Address - Country:US
Mailing Address - Phone:936-581-0188
Mailing Address - Fax:
Practice Address - Street 1:196 PINEY WOODS RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-3608
Practice Address - Country:US
Practice Address - Phone:936-581-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty