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General NPI Number Information
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NPI Number | 1295089027
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Entity Type | Individual
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Provider Name | KELBY STOUT PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 335 FAIRIVEW ST
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City | SILVERTON
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State | OR
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Zip | 97381-1200
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Country | US
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Telephone | 503-873-8686
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Fax | 503-873-8689
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Provider Business Mailing Address
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Address Line | 335 FAIRIVEW ST
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City | SILVERTON
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State | OR
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Zip | 97381-1200
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Country | US
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Telephone | 503-873-8686
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Fax | 503-873-8689
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA160806
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License Number State | OR
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