Individual provider Active NPI

Tynisha Stewart, OQP

  • Adult Companion
  • Sacramento, CA
National Provider Identifier
1609757764
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult CompanionTaxonomy code 372600000X
License
D2911902 Issued in CA
Practice address
630 Bercut Dr Ste C
Sacramento, CA 95811-0110
Phone
(916) 363-1553
Fax
(916) 363-1638
NPI assigned
Sep 8, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Companion 372600000X D2911902 CA Primary

Addresses

Primary practice location

630 Bercut Dr Ste C
Sacramento, CA 95811-0110

Mailing address

3841 N Freeway Blvd Ste 245
Sacramento, CA 95834-1969
Phone (916) 441-0226

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

LicenseStateTypeSpecialty
D2911902CAMDAdult Companion

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1609757764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 N FREEWAY BLVD STE 245",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958341969",
            "telephone_number": "916-441-0226",
            "fax_number": "916-441-0286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 BERCUT DR STE C",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958110110",
            "telephone_number": "916-363-1553",
            "fax_number": "916-363-1638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "TYNISHA",
        "credential": "OQP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-08",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "CA",
            "license": "D2911902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.