Provider Demographics
NPI:1245191253
Name:STEWART, KALEY ANN (MMS, PA-C)
Entity type:Individual
Prefix:MS
First Name:KALEY
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1507
Mailing Address - Country:US
Mailing Address - Phone:708-969-2964
Mailing Address - Fax:
Practice Address - Street 1:7786 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1583
Practice Address - Country:US
Practice Address - Phone:708-425-3085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.011683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant