Individual
MS. ANDREA KATHRYN STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1019 VALMEYER RD, COLUMBIA, IL 62236-4123
(618) 205-7170
Mailing address
1019 VALMEYER RD, COLUMBIA, IL 62236-4123
(618) 205-7170
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004179
IL
Other
Enumeration date
12/07/2011
Last updated
08/07/2024
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