MEDICARE: SARAH STOUT PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	101.0134939	VT

General Provider Information

NPI Number	:	1366118937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH STOUT PMHNP-BC

Provider Business Mailing Address
First Line	:	171 RIVER RD
Second Line	:
City	:	LEYDEN
State	:	MA
Zip	:	01337-9740
Country	:	US
Telephone Number	:	413-313-8285
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 WESTERN AVE
Second Line	:
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-6093
Country	:	US
Telephone Number	:	802-254-0252
Fax Number	:	802-254-0253

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

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	07/26/2023

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Directions to “ SARAH STOUT PMHNP-BC” Practice Location

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