Provider Demographics
NPI:1427856152
Name:STEWART, DOROTHY (NP)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:STEWART
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ELCREST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-3232
Mailing Address - Country:US
Mailing Address - Phone:601-863-6978
Mailing Address - Fax:
Practice Address - Street 1:3531 LAKELAND DR STE 1060
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8016
Practice Address - Country:US
Practice Address - Phone:601-420-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907285363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health