Individual
KENNETH C. STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1101 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5291
Mailing address
1101 JACKSON ST SW, SUITE B, GRAVETTE, AR 72736-9121
(479) 787-5291
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2006005756
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245209501
—
MO
05
—
165354003
—
AR
Enumeration date
03/17/2006
Last updated
04/03/2017
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