Individual provider Active NPI

Deborah Margaret Stewart, FNP-C, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Aurora, IL
National Provider Identifier
1740568815
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
277003688 Issued in IL
Practice address
400 Mercy LN
Aurora, IL 60506-2447
Phone
(877) 381-6538
Fax
(877) 381-6538
NPI assigned
Jul 23, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X RN124133 GA
Family Nurse Practitioner 363LF0000X RN124133 GA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN124133 GA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 277003688 IL Primary

Addresses

Primary practice location

400 Mercy LN
Aurora, IL 60506-2447

Mailing address

229 Larue LN
Collins, GA 30421-6638
Phone (912) 577-5372

Other practice location 1

229 LaRue Ln
Collins, GA 30421-6638
Phone (912) 577-5372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170210000617 GA Practitioner - Nurse Practitioner 4183907421 Reassigns benefits to 1 organization
Practice locations: Collins, GA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN124133GAMDAdult Psychiatric/Mental Health Registered Nurse
277003688ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Connection Counseling Center LLC Psychiatric/Mental Health CurrentSince Jun 22, 2020 Accepting new patients
Pruitthealth Physicians Services, LLC Nurse Practitioner CurrentSince Jan 28, 2017 Accepting new patients

Locations

1626 Jeurgens Ct
Norcross, GA 30093
Phone (770) 806-6875

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1311379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745366400000",
    "number": "1740568815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 LARUE LN",
            "city": "COLLINS",
            "state": "GA",
            "postal_code": "304216638",
            "telephone_number": "912-577-5372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MERCY LN",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605062447",
            "telephone_number": "877-381-6538",
            "fax_number": "877-381-6538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "229 LaRue Ln",
            "address_purpose": "LOCATION",
            "city": "Collins",
            "state": "GA",
            "postal_code": "304216638",
            "country_code": "US",
            "telephone_number": "912-577-5372",
            "fax_number": "912-693-6192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEWART",
        "first_name": "DEBORAH",
        "middle_name": "MARGARET",
        "name_prefix": "Mrs.",
        "credential": "FNP-C, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-23",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "GA",
            "license": "RN124133",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN124133",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN124133",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277003688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

Verify at the official NPI Registry.