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General NPI Number Information
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NPI Number | 1326455650
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Entity Type | Individual
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Provider Name | KRISTEN ELISE STOUT ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 207 STONEVIEW LN
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City | MOORESVILLE
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State | IN
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Zip | 46158-2747
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Country | US
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Telephone | 317-750-9775
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Fax |
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Provider Business Mailing Address
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Address Line | 8126 W 88TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1116
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Country | US
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Telephone |
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36002158A
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License Number State | IN
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