Provider Demographics
NPI:1083691851
Name:STOUT, CHRISTINA E (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:E
Last Name:STOUT
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 1:1739 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2203
Mailing Address - Country:US
Mailing Address - Phone:330-262-2500
Mailing Address - Fax:330-264-8713
Practice Address - Street 1:1739 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2203
Practice Address - Country:US
Practice Address - Phone:330-262-2500
Practice Address - Fax:330-264-8713
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07951363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2524432Medicaid
OHQ24130Medicare UPIN