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NPI Code Detail

MEDICARE: LISA ELAINE STOUT APRN-CNM

MEDICARE: LISA ELAINE STOUT APRN-CNM
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
1367A00000XAdvanced Practice Midwife50604OK

Other Identifiers

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

General Provider Information

NPI Number : 1952502064
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ELAINE STOUT APRN-CNM
Provider Business Mailing Address
First Line : 1200 E PECAN ST
Second Line :
City : ALTUS
State : OK
Zip : 73521-6141
Country : US
Telephone Number : 580-379-5000
Fax Number : 580-379-5509
Provider Business Practice Location Address
First Line : 101 S PARK LN STE 200
Second Line :
City : ALTUS
State : OK
Zip : 73521-5731
Country : US
Telephone Number : 580-379-6140
Fax Number : 580-379-6149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 07/26/2024

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1922060243 — DR. VICENTE YAMIL SANCHEZ M.D.
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Directions to “ LISA ELAINE STOUT APRN-CNM” Practice Location

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