Provider Demographics
NPI:1104096882
Name:STOUT, KIMBERLY A (MED, CCC-A, FAAA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:STOUT
Suffix:
Gender:F
Credentials:MED, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1911
Mailing Address - Street 2:45 N. MAIN STREET
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482
Mailing Address - Country:US
Mailing Address - Phone:804-435-0758
Mailing Address - Fax:804-435-7226
Practice Address - Street 1:45 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-0758
Practice Address - Fax:804-435-7226
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01101231H00000X
VA2201001078231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist