Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2015017864 | MO |
NPI | 1063878486 |
---|---|
Provider Name | Alyson Stout |
First Address | Neosho, MO 64850-1109 |
Second Address | Neosho, MO 64850-1424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2016 |
Last Update Date | 14/01/2016 |