Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 026236 | LA |
N | 208000000X | Pediatrician | ME98533 | FL |
NPI | 1003924978 |
---|---|
Provider Name | Jessica Turner Stewart |
First Address | Slidell, LA 70458-3206 |
Second Address | Slidell, LA 70458 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 14/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1052302 | (05) | LA |
278004600 | (05) | FL |
AA1500 | MEDICARE PTAN (01) | FL |