Healthcare Provider Details

I. General information

NPI: 1306899802
Provider Name (Legal Business Name): PAMELA SUE STOUT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E 20TH ST
HOPE AR
71801-8215
US

IV. Provider business mailing address

202 E 20TH ST
HOPE AR
71801-8215
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-9051
  • Fax: 870-777-3104
Mailing address:
  • Phone: 870-777-9051
  • Fax: 870-777-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR33155
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: