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General NPI Number Information
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NPI Number | 1679932008
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Entity Type | Individual
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Provider Name | MRS. KELLEY STOUT
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Gender | Female
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 3158 DIXIE HWY
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City | ERLANGER
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State | KY
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Zip | 41018-1850
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Country | US
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Telephone | 859-344-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 121 WOODSPOINT DR
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-2295
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Country | US
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Telephone | 859-816-7610
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 014068
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License Number State | KY
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