Individual
MS. KELLY LYNN STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1850 SW FOUNTAINVIEW BLVD STE 105, PORT ST LUCIE, FL 34986-4527
(772) 336-2818
Mailing address
1850 SW FOUNTAINVIEW BLVD STE 105, PORT ST LUCIE, FL 34986-4527
(772) 336-2818
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
11030455
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780072330
—
NC
05
—
NP3486
—
SC
Enumeration date
01/06/2015
Last updated
01/31/2024
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