Provider Demographics
NPI:1376692384
Name:STOUT, PENNY (RN APRN)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:RN APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 WINEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2377
Mailing Address - Country:US
Mailing Address - Phone:919-943-9407
Mailing Address - Fax:
Practice Address - Street 1:311 TRENT DRIVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-681-2237
Practice Address - Fax:919-681-8521
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106077207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P97632Medicare ID - Type Unspecified
NC2809500Medicare ID - Type Unspecified