MEDICARE: KERRICK LOUIS STOUT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4902	AK
2	207Q00000X	Family Medicine Physician	34237	KY
3	207P00000X	Emergency Medicine Physician	34237	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710961172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRICK LOUIS STOUT MD

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576-0130
Country	:	US
Telephone Number	:	907-842-9218
Fax Number	:	907-842-9500

Provider Business Practice Location Address
First Line	:	6000 KANAKANAK RD
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576
Country	:	US
Telephone Number	:	907-842-5201
Fax Number	:	907-842-9250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	03/11/2015

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Directions to “ KERRICK LOUIS STOUT MD” Practice Location

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