Individual
KELLY STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, AGPCNP-C
Contact information
Practice address
19657 S LA GRANGE RD, MOKENA, IL 60448-9360
(708) 476-8205
(708) 995-7144
Mailing address
19657 S LA GRANGE RD, MOKENA, IL 60448-9360
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.034209
IL
363LG0600X
Gerontology Nurse Practitioner
71018107A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300131930
—
IN
Enumeration date
02/10/2026
Last updated
06/23/2026
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