Provider Demographics
NPI:1386725497
Name:STOUT, DEBORA ANNE (MN, PMHNP)
Entity type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:ANNE
Last Name:STOUT
Suffix:
Gender:F
Credentials:MN, PMHNP
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 1310
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103
Mailing Address - Country:US
Mailing Address - Phone:503-338-6106
Mailing Address - Fax:503-338-6126
Practice Address - Street 1:818 COMMERCIAL ST, SUITE 400
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103
Practice Address - Country:US
Practice Address - Phone:503-338-6106
Practice Address - Fax:503-338-6126
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081001680 N6363LP0808X
OR081001680N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S-49217Medicare UPIN
ORS-49217Medicare UPIN