Provider Demographics
NPI:1932276417
Name:STEWART, KRISTINA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 N LIDGERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1225
Mailing Address - Country:US
Mailing Address - Phone:509-455-4455
Mailing Address - Fax:
Practice Address - Street 1:5715 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1225
Practice Address - Country:US
Practice Address - Phone:509-455-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60041683363A00000X, 363A00000X
WAOA60790137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA246224OtherL&I
WA246224OtherL&I