Active NPI
Jackson L Stewart, PSYCHOLOGIST
- Psychologist
- Bradford, PA
National Provider Identifier
1003328378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS004481L
- Practice address
- 110 Campus Dr
Bradford, PA 16701-1982 - Phone
- (814) 362-6535
- NPI assigned
- Oct 26, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS004481L | PA | Primary |
Addresses
Primary practice location
110 Campus Dr
Bradford, PA 16701-1982
Mailing address
110 Campus Dr
Bradford, PA 16701-1982
Phone (814) 362-6535
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS004481L | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508976000000",
"number": "1003328378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 CAMPUS DR",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167011982",
"telephone_number": "814-362-6535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 CAMPUS DR",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167011982",
"telephone_number": "814-362-6535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART",
"first_name": "JACKSON",
"middle_name": "L",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-26",
"last_updated": "2017-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS004481L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bradford, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.