Individual
JAN DAWN BAILEY STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
26 MIDWAY ST, BRISTOL, TN 37620-1706
(423) 989-4500
(423) 989-4582
Mailing address
1167 SPRATLIN PARK DR, GRAY, TN 37615-6205
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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