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NPI Code Detail

MEDICARE: KELLY ANN STOUT

MEDICARE:   KELLY ANN STOUT
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1255673810
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ANN STOUT
Provider Business Mailing Address
First Line : 7668 FRIENDLY BREEZE CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-1301
Country : US
Telephone Number : 702-544-0076
Fax Number :
Provider Business Practice Location Address
First Line : 2980 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-5656
Country : US
Telephone Number : 702-544-0076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2013
Last Update Date : 03/21/2013

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Directions to “ KELLY ANN STOUT ” Practice Location

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