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General NPI Number Information
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NPI Number | 1386596724
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Entity Type | Individual
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Provider Name | KELLY STOUT APRN, AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 19657 S LA GRANGE RD
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City | MOKENA
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State | IL
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Zip | 60448-9360
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Country | US
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Telephone | 708-476-8205
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Fax | 708-995-7144
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Provider Business Mailing Address
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Address Line | 6009 E 141ST AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-9074
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Country | US
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Telephone | 708-751-0531
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.034209
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License Number State | IL
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