Provider Demographics
NPI:1588400170
Name:STEWART, KEAUNYA MONAE
Entity type:Individual
Prefix:MISS
First Name:KEAUNYA
Middle Name:MONAE
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 1:1205 ROSEHILL RD APT 106
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1977
Mailing Address - Country:US
Mailing Address - Phone:740-990-6402
Mailing Address - Fax:
Practice Address - Street 1:1205 ROSEHILL RD APT 106
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1977
Practice Address - Country:US
Practice Address - Phone:740-990-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01022023374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide