MEDICARE: RACHEL RENEE STOUT RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2008022137	MO

General Provider Information

NPI Number	:	1235712142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL RENEE STOUT RN

Provider Business Mailing Address
First Line	:	295 RIDGE TRAIL DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3061
Country	:	US
Telephone Number	:	217-414-6702
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 RIDGE TRAIL DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3061
Country	:	US
Telephone Number	:	217-414-6702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	04/29/2021

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