Provider Demographics
NPI:1366177412
Name:STEWART, CYREESE DENISE (PRESIDENT)
Entity type:Individual
Prefix:MISS
First Name:CYREESE
Middle Name:DENISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11230 PARADISE OUT LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-3101
Mailing Address - Country:US
Mailing Address - Phone:405-992-2972
Mailing Address - Fax:
Practice Address - Street 1:11230 PARADISE OUT LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-3101
Practice Address - Country:US
Practice Address - Phone:405-653-5740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK146D00000X, 171400000X, 172V00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker