MEDICARE: KELLY A SCOTT CRNP

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	363LW0102X	Women's Health Nurse Practitioner	UP005628V	PA
2	363LW0102X	Women's Health Nurse Practitioner	15562-NP	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	UP005628V	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457406100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY A SCOTT CRNP

Provider Business Mailing Address
First Line	:	178 WINDOVER DR
Second Line	:
City	:	MIDLAND
State	:	PA
Zip	:	15059-2216
Country	:	US
Telephone Number	:	724-843-4010
Fax Number	:	724-846-0588

Provider Business Practice Location Address
First Line	:	178 WINDOVER DR
Second Line	:
City	:	MIDLAND
State	:	PA
Zip	:	15059-2216
Country	:	US
Telephone Number	:	724-843-4010
Fax Number	:	724-846-0588

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	11/02/2023

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