Derek Stewart Jr., MS

Key facts

NPI

1720434293

Entity type

Individual (NPI type 1)

Primary specialty

Case Manager/Care Coordinator 171M00000X

Practice address

1614 E Main St Ste D
New Iberia, LA 70560-4056

Phone

(337) 256-5917

NPI assigned

May 13, 2016

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Science

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 3, 2020.

{
    "created_epoch": "1463097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1720434293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 E MAIN ST STE D",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705604056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 E MAIN ST STE D",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705604056",
            "telephone_number": "337-256-5917"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "850 Kaliste Saloom Rd Ste 117",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "LA",
            "postal_code": "705084230",
            "country_code": "US",
            "telephone_number": "337-234-7109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEWART",
        "first_name": "DEREK",
        "name_suffix": "Jr.",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-13",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1467745000",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in New Iberia, LA · Case Manager/Care Coordinator in Louisiana