=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114459567
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BILLIE SALINA STOUT FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2017
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 MIMS RD
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30467-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-451-5887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 MIMS RD
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30467-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-451-5887
-----------------------------------------------------
Fax | 478-237-9138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN155792
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------