Active NPI
Jeremy Wayne Stout, PH.D.
- Clinical Psychologist
- Richmond, VA
National Provider Identifier
1003370321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY10800
- Practice address
- 1207 Broad Rock Blvd
Richmond, VA 23249-1899 - Phone
- (804) 675-5000
- NPI assigned
- Jan 31, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY10800 | FL | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1207 Broad Rock Blvd
Richmond, VA 23249-1899
Mailing address
269 Lookout Hill Rd
Milford, CT 06461-1899
Phone (808) 375-4414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY10800 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712188800000",
"number": "1003370321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "269 LOOKOUT HILL RD",
"city": "MILFORD",
"state": "CT",
"postal_code": "064611899",
"telephone_number": "808-375-4414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1207 BROAD ROCK BLVD",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232491899",
"telephone_number": "804-675-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOUT",
"first_name": "JEREMY",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-31",
"last_updated": "2024-04-04",
"certification_date": "2024-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY10800",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.