Provider Demographics
NPI:1134614928
Name:STEWART, KAITLEN FAITH
Entity type:Individual
Prefix:
First Name:KAITLEN
Middle Name:FAITH
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 1:11524 N RODNEY PARHAM RD STE 8
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4169
Mailing Address - Country:US
Mailing Address - Phone:501-954-7822
Mailing Address - Fax:
Practice Address - Street 1:11524 N RODNEY PARHAM RD STE 8
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4169
Practice Address - Country:US
Practice Address - Phone:501-954-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty