Healthcare Provider Details

I. General information

NPI: 1508894528
Provider Name (Legal Business Name): TAMMY L STOUT ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY L HANSON

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 COLLEGE ST # 100
BEAUMONT TX
77701-4612
US

IV. Provider business mailing address

3406 COLLEGE ST # 200
BEAUMONT TX
77701-4612
US

V. Phone/Fax

Practice location:
  • Phone: 409-813-1677
  • Fax: 409-951-1691
Mailing address:
  • Phone: 409-730-2068
  • Fax: 409-232-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number541827
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP111209
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: