Provider Demographics
NPI:1902461239
Name:STEWART, AMY MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 CHAUGA DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29626-1234
Mailing Address - Country:US
Mailing Address - Phone:864-940-0671
Mailing Address - Fax:
Practice Address - Street 1:1 HAVENWOOD LN
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-9680
Practice Address - Country:US
Practice Address - Phone:864-834-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22791363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health