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
Phone: (772) 336-2818
Fax:
Website:
Health care specialties
| Specialty | Code | License # | 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 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780072330 | NPPES |
| North Carolina | MEDICAID | 1780072330 | |
| North Carolina | MEDICAID | NP3486 |
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