MEDICARE: DESIREE DOMINIQUE 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1629615653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE DOMINIQUE SCOTT

Provider Business Mailing Address
First Line	:	12074 NEWCASTLE AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8998
Country	:	US
Telephone Number	:	318-493-1474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 SILVERSIDE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4179
Country	:	US
Telephone Number	:	225-939-1324
Fax Number	:

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

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	06/14/2021

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