Provider Demographics
NPI:1487087607
Name:STEWART, KAREN P
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:P
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 SOUTHERLAND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4825
Mailing Address - Country:US
Mailing Address - Phone:601-266-4282
Mailing Address - Fax:601-366-4287
Practice Address - Street 1:2624 SOUTHERLAND ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4825
Practice Address - Country:US
Practice Address - Phone:601-266-4282
Practice Address - Fax:601-366-4287
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM05181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical