Individual
LISA A STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 988-5281
Mailing address
965 RIDGE LAKE BLVD STE 315, MEMPHIS, TN 38120-9401
(706) 447-7145
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
738107
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03870528
—
MS
05
—
2138707
—
LA
01
—
R738107
LICENSE
MS
Enumeration date
02/08/2010
Last updated
03/01/2024
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