Provider Demographics
NPI:1548834476
Name:STEWART, LISA CAROL (AGAC-NP BC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CAROL
Last Name:STEWART
Suffix:
Gender:F
Credentials:AGAC-NP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 8TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2619
Mailing Address - Country:US
Mailing Address - Phone:817-529-9199
Mailing Address - Fax:
Practice Address - Street 1:800 8TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2619
Practice Address - Country:US
Practice Address - Phone:817-529-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019615363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology