Provider Demographics
NPI:1699146191
Name:STOUT, JENNIFER KATHLEEN (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATHLEEN
Last Name:STOUT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KATHLEEN
Other - Last Name:DOWNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:847 AKUMU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3837
Mailing Address - Country:US
Mailing Address - Phone:919-862-7495
Mailing Address - Fax:806-401-0101
Practice Address - Street 1:320 WARD AVE # 804
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4001
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-10
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF1214439363LF0000X
HIRN-102900-0363LF0000X
TXAP134260363LF0000X
HIAPRN-3379-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily