MEDICARE: JESSICA RENEE SCOTT MSN, APRN, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN255829	GA

General Provider Information

NPI Number	:	1548845795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RENEE SCOTT MSN, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	560 THORNTON RD STE 120
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-1659
Country	:	US
Telephone Number	:	678-840-8446
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 THORNTON RD STE 120
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-1659
Country	:	US
Telephone Number	:	678-840-8446
Fax Number	:

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

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	04/27/2021

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