Healthcare Provider Details

I. General information

NPI: 1245876572
Provider Name (Legal Business Name): MISS MORGAN PAIGE STOUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 PIONEER LN
GENTRY AR
72734-8876
US

IV. Provider business mailing address

1295 PIONEER LN
GENTRY AR
72734-8876
US

V. Phone/Fax

Practice location:
  • Phone: 479-736-2380
  • Fax:
Mailing address:
  • Phone: 479-736-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number742
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: