Healthcare Provider Details

I. General information

NPI: 1023092608
Provider Name (Legal Business Name): KATHRYN K STOUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 DMV DR
KILMARNOCK VA
22482-3843
US

IV. Provider business mailing address

7130 GLEN FOREST DR SUITE 101
RICHMOND VA
23226-3754
US

V. Phone/Fax

Practice location:
  • Phone: 804-436-8038
  • Fax: 804-435-6029
Mailing address:
  • Phone: 804-288-4048
  • Fax: 804-282-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101046636
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: