Individual
KELLEY MAUREEN STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
166 SOUTH AVE, PENN YAN, NY 14527-1820
(315) 729-0021
(315) 531-2268
Mailing address
166 SOUTH AVE, PENN YAN, NY 14527-1820
(315) 729-0021
(315) 531-2268
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F30-302516
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02049594
—
NY
Enumeration date
08/16/2007
Last updated
08/16/2007
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