Provider Demographics
NPI:1023092608
Name:STOUT, KATHRYN K (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:K
Last Name:STOUT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-288-4048
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:102 DMV DR
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3843
Practice Address - Country:US
Practice Address - Phone:804-436-8038
Practice Address - Fax:804-435-6029
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101046636207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023092608Medicaid
VA1023092608Medicaid
VAVAA113151Medicare PIN