Provider Demographics
NPI:1053876722
Name:STOUT, KRISTEN LYNN (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:STOUT
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 W THUNDERBIRD RD STE 155
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4238
Mailing Address - Country:US
Mailing Address - Phone:623-249-2100
Mailing Address - Fax:623-476-7305
Practice Address - Street 1:3648 W ANTHEM WAY STE A100
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-7002
Practice Address - Country:US
Practice Address - Phone:623-434-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ221035363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care