Stout, Kelly Lynn

Stout, Kelly Lynn is an individual health care provider with primary practice located at 1850 Sw Fountainview Blvd Ste 105 , Port St Lucie FL 34986-4527. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Stout, Kelly Lynn can be contacted via phone (772) 336-2818.

Contact Information

Primary practice address
1850 Sw Fountainview Blvd Ste 105 Port St Lucie FL 34986-4527
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 11030455 Florida

Profile Details

NPI number 1780072330
LBN Legal business name Stout, Kelly Lynn
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 6th, 2015
Last updated Jan 31st, 2024 - about 11 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780072330 NPPES
North Carolina MEDICAID 1780072330
North Carolina MEDICAID NP3486

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