Individual
MS. KATHY JO STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
66 BRAMHALL ST, PORTLAND, ME 04102
(207) 662-4582
Mailing address
39 WALLACE AVE, SOUTH PORTLAND, ME 04106-6143
(207) 761-0650
(207) 761-8198
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP081062
ME
363LA2200X
Adult Health Nurse Practitioner
R045583
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30347768
—
NH
05
—
420670099
—
ME
Enumeration date
10/22/2008
Last updated
02/22/2010
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