Provider Demographics
NPI:1982154936
Name:STEWART, KRISTIN KATHLEEN (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KATHLEEN
Last Name:STEWART
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 MACON TER STE 103
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8505
Mailing Address - Country:US
Mailing Address - Phone:901-791-2892
Mailing Address - Fax:901-791-4872
Practice Address - Street 1:8316 MACON TER STE 103
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8505
Practice Address - Country:US
Practice Address - Phone:901-791-2892
Practice Address - Fax:901-791-4872
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21943363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025599Medicaid