Provider Demographics
NPI:1275902397
Name:STOUT, KEVAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVAN
Middle Name:
Last Name:STOUT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 E TIARA PINES CIR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3926
Mailing Address - Country:US
Mailing Address - Phone:316-259-4791
Mailing Address - Fax:
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3260
Practice Address - Country:US
Practice Address - Phone:816-421-3700
Practice Address - Fax:816-421-3700
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical