Provider Demographics
NPI:1033127071
Name:STOUGHTON, PATRICIA M (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:STOUGHTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 ROUTE 42
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1794
Mailing Address - Country:US
Mailing Address - Phone:856-885-4579
Mailing Address - Fax:
Practice Address - Street 1:4361 ROUTE 42
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1794
Practice Address - Country:US
Practice Address - Phone:856-885-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00095500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0086631Medicaid
099009AQAMedicare ID - Type Unspecified
Q65609Medicare UPIN
NJ099009XVAMedicare PIN