Basic Information
| Provider Information | |||||||||
| NPI: | 1558828574 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | KAPRICE | ||||||||
| MiddleName: | DOMINIQUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5810 CHATFORD DR APT F | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432323180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142848418 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2540 BILLINGSLEY RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432351990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146026473 | ||||||||
| FaxNumber: | 6146026493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2019 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | OH | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.