Provider Demographics
NPI:1538829395
Name:STEWART, TRACY INEZ (NP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:INEZ
Last Name:STEWART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CYPRESSWOOD DR APT 6105
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4707
Mailing Address - Country:US
Mailing Address - Phone:225-572-9801
Mailing Address - Fax:
Practice Address - Street 1:4714 FARM TO MARKET
Practice Address - Street 2:1488 STE #132
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:78384
Practice Address - Country:US
Practice Address - Phone:877-868-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily