| Doctor Name: | KELBY STOUT |
| NPI Number: | 1295089027 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA160806 |
| Business Practice Address: | 335 Fairivew St Silverton, OR - 973811200 |
| Business Phone Number: | 5038738686 |
| Business Fax Number: | 5038738689 |
| Mailing Address: | 335 Fairivew St, SILVERTON |
| State: | OR |
| Postal Code: | 973811200 |
| Phone Number: | 5038738686 |
| Fax Number: | 5038738689 |
| NPI Enumeration Date: | 10/31/2012 |
| NPI Last Update Date: | 03/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA160806 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |