MEDICARE: KENDRA MONIQUE SCOTT

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	363LG0600X	Gerontology Nurse Practitioner	1106456	TX
2	363LA2200X	Adult Health Nurse Practitioner	1106456	TX
3	363LA2100X	Acute Care Nurse Practitioner	1106456	TX

General Provider Information

NPI Number	:	1518668607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA MONIQUE SCOTT

Provider Business Mailing Address
First Line	:	1908 N LAURENT ST STE 250
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-5417
Country	:	US
Telephone Number	:	361-576-0694
Fax Number	:

Provider Business Practice Location Address
First Line	:	2806 REAL ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78722-1715
Country	:	US
Telephone Number	:	361-827-8147
Fax Number	:

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

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	02/04/2026

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