Provider Demographics
NPI:1760180749
Name:STOUT, KRISTA TAYLOR (BA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:TAYLOR
Last Name:STOUT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N ALAMEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2291
Mailing Address - Country:US
Mailing Address - Phone:575-649-1410
Mailing Address - Fax:
Practice Address - Street 1:920 N ALAMEDA BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2291
Practice Address - Country:US
Practice Address - Phone:575-649-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool