Provider Demographics
NPI:1508894528
Name:STOUT, TAMMY L (ACNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:STOUT
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3406 COLLEGE ST # 200
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4612
Mailing Address - Country:US
Mailing Address - Phone:409-730-2068
Mailing Address - Fax:409-232-0559
Practice Address - Street 1:3406 COLLEGE ST # 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4612
Practice Address - Country:US
Practice Address - Phone:409-813-1677
Practice Address - Fax:409-951-1691
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541827363L00000X
TXAP111209363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner