Provider Demographics
NPI:1023453560
Name:STOUT, LAURA ELIZABETH (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:STOUT
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:MONNAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CDN
Mailing Address - Street 1:11524 S HIWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-8819
Mailing Address - Country:US
Mailing Address - Phone:585-727-2035
Mailing Address - Fax:
Practice Address - Street 1:2405 PALMER CIR STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6351
Practice Address - Country:US
Practice Address - Phone:405-561-7928
Practice Address - Fax:405-310-9944
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1084504133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered