Kelley Maureen Stout, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F30-302516 Issued in NY

Practice address

166 South Ave
Penn Yan, NY 14527-1820

Phone

(315) 729-0021

Fax

(315) 531-2268

NPI assigned

Aug 16, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kelley Stout Barry Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187222400000",
    "number": "1407048150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 SOUTH AVE",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271820",
            "telephone_number": "315-729-0021",
            "fax_number": "315-531-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 SOUTH AVE",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271820",
            "telephone_number": "315-729-0021",
            "fax_number": "315-531-2268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUT",
        "first_name": "KELLEY",
        "middle_name": "MAUREEN",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-16",
        "last_updated": "2007-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F30-302516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02049594",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "BARRY",
            "middle_name": "STOUT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Adult Health Nurse Practitioner in Penn Yan, NY
• Providers in Penn Yan, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.