Provider Demographics
NPI:1699593657
Name:STEWART, RICKI ALEXIS
Entity type:Individual
Prefix:
First Name:RICKI
Middle Name:ALEXIS
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 1:4589 RHEA COUNTY HWY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-6076
Mailing Address - Country:US
Mailing Address - Phone:423-428-9550
Mailing Address - Fax:
Practice Address - Street 1:4589 RHEA COUNTY HWY STE 300
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-6077
Practice Address - Country:US
Practice Address - Phone:423-428-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95368164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse