Provider Demographics
NPI:1679782742
Name:TROUT, STACY RENEE' (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:RENEE'
Last Name:TROUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:RENEE'
Other - Last Name:ZOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:923 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:923 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2429
Practice Address - Country:US
Practice Address - Phone:620-285-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01259363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant