Healthcare Provider Details

I. General information

NPI: 1134547094
Provider Name (Legal Business Name): NICOLE A. STOUGHTON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 04/02/2024
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY MEDICAL CENTER 8901 ROCKVILLE PIKE, BUILDING 85T
BETHESDA MD
20889
US

IV. Provider business mailing address

WALTER REED NATIONAL MILITARY MEDICAL CENTER 8901 ROCKVILLE PIKE, BUILDING 85T
BETHESDA MD
20889
US

V. Phone/Fax

Practice location:
  • Phone: 301-400-2110
  • Fax:
Mailing address:
  • Phone: 301-400-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1458
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 1458
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: