Provider Demographics
NPI:1043729601
Name:STOUT, SCOTT (FNP-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:STOUT
Suffix:
Gender:M
Credentials: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:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79702-0164
Mailing Address - Country:US
Mailing Address - Phone:432-687-2273
Mailing Address - Fax:432-687-1016
Practice Address - Street 1:3952 E 42ND ST STE Z
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5942
Practice Address - Country:US
Practice Address - Phone:432-614-5327
Practice Address - Fax:432-614-5784
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily