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General NPI Number Information
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NPI Number | 1891116216
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Entity Type | Individual
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Provider Name | HEATHER STOUT
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Gender | Female
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 08/13/2015
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Provider Practice Location Address
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Address Line | 605 E HOLLAND AVE STE 101
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City | SPOKANE
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State | WA
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Zip | 99218-1246
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Country | US
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Telephone | 509-838-2531
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Fax | 509-755-6580
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Provider Business Mailing Address
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Address Line | PO BOX 3649
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City | SPOKANE
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State | WA
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Zip | 99220-3649
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60436631
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA60436631
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License Number State | WA
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