Provider Demographics
NPI:1750891214
Name:STOUT, MONICA L (PMHNP-BC FNP-C)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:STOUT
Suffix:
Gender:F
Credentials:PMHNP-BC FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 LAKE POINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4076
Mailing Address - Country:US
Mailing Address - Phone:708-505-5476
Mailing Address - Fax:
Practice Address - Street 1:1235 LAKE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4076
Practice Address - Country:US
Practice Address - Phone:708-505-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX930911363LF0000X
TXAP135903363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX397202802Medicaid
TX397202803Medicaid