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General NPI Number Information
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NPI Number | 1992773840
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Entity Type | Individual
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Provider Name | BRENDA M STOUT PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 6555 FOURTH SECTION RD
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City | BROCKPORT
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State | NY
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Zip | 14420-2441
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Country | US
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Telephone | 585-315-3644
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Fax | 585-431-5365
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Provider Business Mailing Address
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Address Line | 6668 FOURTH SECTION RD
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City | BROCKPORT
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State | NY
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Zip | 14420-2448
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Country | US
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Telephone | 585-368-6870
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Fax | 585-368-6871
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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 | 005069
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License Number State | NY
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