Provider Demographics
NPI:1659136653
Name:STOUGHTON, DEZERAY
Entity Type:Individual
Prefix:
First Name:DEZERAY
Middle Name:
Last Name:STOUGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEZERAY
Other - Middle Name:
Other - Last Name:BUTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2447 STATE ROUTE 133
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-9535
Mailing Address - Country:US
Mailing Address - Phone:513-240-3720
Mailing Address - Fax:
Practice Address - Street 1:2447 STATE ROUTE 133
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-9535
Practice Address - Country:US
Practice Address - Phone:513-240-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide