Individual
MRS. KRISTEN ELISE STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
207 STONEVIEW LN, MOORESVILLE, IN 46158-2747
(317) 750-9775
Mailing address
8126 W 88TH ST, INDIANAPOLIS, IN 46278-1116
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002158A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000014406
NATA CERTIFICATION
—
01
—
36002158A
INDIANA AT LICENSURE
IN
Enumeration date
07/18/2014
Last updated
06/04/2024
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