Provider Demographics
NPI:1629789276
Name:STOUT, KRISTINA MARIE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:STOUT
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:CORRIVEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11917 S NORWOOD AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5509
Mailing Address - Country:US
Mailing Address - Phone:918-779-0642
Mailing Address - Fax:918-393-8002
Practice Address - Street 1:11917 S NORWOOD AVE STE 112
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-5509
Practice Address - Country:US
Practice Address - Phone:918-779-0642
Practice Address - Fax:918-393-8002
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK210451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201142270AMedicaid