Alyssa Ann Stout, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

857 Issued in NH

Practice address

325 S 1St Ave
Broken Bow, NE 68822-2213

Phone

(308) 872-5111

Fax

(308) 872-5115

NPI assigned

Jun 20, 2023

Last updated

Jun 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Alyssa Ann Corbin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1477238178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 S 1ST AVE",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688222213",
            "telephone_number": "308-872-5111",
            "fax_number": "308-872-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 S 1ST AVE",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688222213",
            "telephone_number": "308-872-5111",
            "fax_number": "308-872-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUT",
        "first_name": "ALYSSA",
        "middle_name": "ANN",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NH",
            "license": "857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "CORBIN",
            "middle_name": "ANN",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Athletic Trainer in Broken Bow, NE
• Providers in Broken Bow, NE by specialty
• Athletic Trainer in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; 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.