Provider Demographics
NPI:1205542941
Name:STOUT, JESSICA NICOLE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:STOUT
Suffix:
Gender:
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 CLARK STATION RD
Mailing Address - Street 2:
Mailing Address - City:FINCHVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40022-5758
Mailing Address - Country:US
Mailing Address - Phone:502-802-2954
Mailing Address - Fax:
Practice Address - Street 1:4003 KRESGE WAY STE 227
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-281-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily