Provider Demographics
NPI:1699478149
Name:STEWART, MARION (FNP-C)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
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 1:114 N LEHMBERG RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5554
Mailing Address - Country:US
Mailing Address - Phone:662-329-2955
Mailing Address - Fax:662-370-1236
Practice Address - Street 1:114 N LEHMBERG RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5554
Practice Address - Country:US
Practice Address - Phone:662-329-2955
Practice Address - Fax:662-370-1236
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905920208000000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208000000XAllopathic & Osteopathic PhysiciansPediatrics