Individual
PHYLLIS J. STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2115 S FREMONT AVE, SUITE 1000, SPRINGFIELD, MO 65804-2239
(417) 820-8099
(417) 820-8093
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
052911
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171792758
—
AR
05
—
429683519
—
MO
01
—
431560263
TRICARE WEST
—
Enumeration date
02/21/2007
Last updated
11/18/2008
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