Provider Demographics
NPI:1790888048
Name:STOUT, JOYCE ANNE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ANNE
Last Name:STOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 75-B
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-9306
Mailing Address - Country:US
Mailing Address - Phone:573-663-2655
Mailing Address - Fax:
Practice Address - Street 1:205 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-0157
Practice Address - Country:US
Practice Address - Phone:573-663-2525
Practice Address - Fax:573-663-7821
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001026512164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse