Provider Demographics
NPI:1881947695
Name:STOUT, LORENA KAY (NP)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:KAY
Last Name:STOUT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N WELO ST
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:ND
Mailing Address - Zip Code:58852-7157
Mailing Address - Country:US
Mailing Address - Phone:701-664-3305
Mailing Address - Fax:
Practice Address - Street 1:810 N WELO ST
Practice Address - Street 2:
Practice Address - City:TIOGA
Practice Address - State:ND
Practice Address - Zip Code:58852-7157
Practice Address - Country:US
Practice Address - Phone:701-664-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR37497163W00000X, 363LF0000X
NC99487363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881947695OtherUNKNOWN
NC1881947695Medicaid