Provider Demographics
NPI:1487950713
Name:STOUT, LYNN E
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:E
Last Name:STOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E NORTHERN LIGHTS BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2814
Mailing Address - Country:US
Mailing Address - Phone:907-333-4343
Mailing Address - Fax:907-333-4383
Practice Address - Street 1:401 E NORTHERN LIGHTS BLVD STE 211
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2814
Practice Address - Country:US
Practice Address - Phone:907-333-4343
Practice Address - Fax:907-333-4383
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH9780Medicaid