Provider Demographics
NPI:1699315192
Name:STEWART, PAUL (FNP-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-1610
Mailing Address - Country:US
Mailing Address - Phone:903-603-7067
Mailing Address - Fax:
Practice Address - Street 1:400 E STATE HIGHWAY 243
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2443
Practice Address - Country:US
Practice Address - Phone:903-287-5011
Practice Address - Fax:903-802-7125
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1044093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily