Individual
KAELEY STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-8573
(503) 494-3457
Mailing address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-8573
(503) 494-3457
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA226904
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
06/04/2024
Last updated
09/03/2025
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