Healthcare Provider Details

I. General information

NPI: 1639209745
Provider Name (Legal Business Name): JULIE MAY STOUT ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE MAY SCHEUMBAUER ANP-BC

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/23/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15945 CLAYTON RD STE 310
BALLWIN MO
63011-2493
US

IV. Provider business mailing address

6 SILVER LN
KIRKWOOD MO
63122-5819
US

V. Phone/Fax

Practice location:
  • Phone: 636-863-1356
  • Fax: 636-893-1358
Mailing address:
  • Phone: 314-278-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number086973
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: