Provider Demographics
NPI:1821032459
Name:ANANDA-STOUT, BETH (PHD, APRN)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:ANANDA-STOUT
Suffix:
Gender:F
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-0917
Mailing Address - Country:US
Mailing Address - Phone:808-936-7795
Mailing Address - Fax:808-935-0777
Practice Address - Street 1:891 ULULANI ST STE 205
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3982
Practice Address - Country:US
Practice Address - Phone:808-936-7795
Practice Address - Fax:808-666-9340
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 106367A00000X, 364SP0808X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife