Timothy Ray Stout, is a medicare enrolled "Student In An Organized Health Care Education/training Program" in Tulsa, Oklahoma. He went to Oklahoma State University College Of Osteopathic Medicine and graduated in 2025 and has 1 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Warren Clinic Inc and his current practice location is
9119 S 90th East Ave, Tulsa, Oklahoma. You can reach out to his office (for appointments etc.) via phone at
(918) 693-0161.
Timothy Ray Stout is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1174307250.
Provider's Profile
| Full Name | Timothy Ray Stout |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Experience | 1 Years |
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| Location | 9119 S 90th East Ave, Tulsa, Oklahoma |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Timothy Ray Stout attended and graduated from Oklahoma State University College Of Osteopathic Medicine in 2025
NPI Data:
- NPI Number: 1174307250
- Provider Enumeration Date: 08/21/2023
- Last Update Date: 08/21/2023
Medicare PECOS Information:
- PECOS PAC ID: 4688155575
- Enrollment ID: I20260227003565
Medical Identifiers
Medical identifiers for Timothy Ray Stout such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1174307250 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Warren Clinic Inc | 8820900293 | 770 |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Timothy Ray Stout is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Timothy Ray Stout,
9119 S 90th East Ave,
Tulsa, OK 74133-5607
Ph: (918) 693-0161 | Timothy Ray Stout,
9119 S 90th East Ave,
Tulsa, OK 74133-5607
Ph: (918) 693-0161 |
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