Healthcare Provider Details

I. General information

NPI: 1104043041
Provider Name (Legal Business Name): DR. ANNA STOUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 PICKETT RD
DURHAM NC
27705-6005
US

IV. Provider business mailing address

3017 PICKETT RD
DURHAM NC
27705-6005
US

V. Phone/Fax

Practice location:
  • Phone: 919-313-3142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number925
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: