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NPI Code Detail

MEDICARE: SCOTT POULSEN

MEDICARE:   SCOTT  POULSEN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1467072207
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT POULSEN
Provider Business Mailing Address
First Line : 424 S LAKE ST
Second Line :
City : PARIS
State : TN
Zip : 38242-4573
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 424 S LAKE ST
Second Line :
City : PARIS
State : TN
Zip : 38242-4573
Country : US
Telephone Number : 817-995-2294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2020
Last Update Date : 04/22/2020

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Directions to “ SCOTT POULSEN ” Practice Location

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