MEDICARE: CRYSTAL SCOTT MS, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	46673	AZ
2	163WD0400X	Diabetes Educator Registered Nurse	831137	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP139739	OTHER	NV	FAMILY NURSE PRACTITIONER
2	926491	OTHER	AZ	REGISTERD DIETITAN
3	831137	OTHER	NV	REGISTERED NURSE

General Provider Information

NPI Number	:	1174169486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL SCOTT MS, FNP

Provider Business Mailing Address
First Line	:	7725 N 43RD AVE STE 111
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5775
Country	:	US
Telephone Number	:	623-931-9201
Fax Number	:	623-931-2116

Provider Business Practice Location Address
First Line	:	6539 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3222
Country	:	US
Telephone Number	:	702-755-2017
Fax Number	:	205-449-6697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	07/18/2025

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