Individual
JENNA LEE SMITH STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CM
Contact information
Practice address
3457 MAIN ST, STONE RIDGE, NY 12484-5612
(845) 430-4300
Mailing address
334 PLAZA RD, KINGSTON, NY 12401-2975
(845) 338-5575
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
F000723
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F000723
LICENSE #
NY
Enumeration date
04/17/2006
Last updated
03/07/2023
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