Provider Demographics
NPI:1770607558
Name:STOUT, FARRAH DANE (BS QMHP)
Entity type:Individual
Prefix:MRS
First Name:FARRAH
Middle Name:DANE
Last Name:STOUT
Suffix:
Gender:F
Credentials:BS QMHP
Other - Prefix:
Other - First Name:FARRAH
Other - Middle Name:DANE
Other - Last Name:RICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:498 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-878-1600
Practice Address - Fax:423-878-1606
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other