Provider Demographics
NPI:1780404152
Name:STOUT, AMBER NICOLE (RN, BSN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:STOUT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 N 880 W
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901
Mailing Address - Country:US
Mailing Address - Phone:765-480-3863
Mailing Address - Fax:
Practice Address - Street 1:210 MEIJER DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905
Practice Address - Country:US
Practice Address - Phone:765-838-5750
Practice Address - Fax:765-838-5751
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28176300C163W00000X
IN28176300A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse