Healthcare Provider Details

I. General information

NPI: 1538110978
Provider Name (Legal Business Name): MITZI S SCOTTEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CHURCH ST STE 400
JONESBORO AR
72401-4112
US

IV. Provider business mailing address

800 S CHURCH ST STE 400
JONESBORO AR
72401-4112
US

V. Phone/Fax

Practice location:
  • Phone: 870-935-6012
  • Fax: 870-934-3156
Mailing address:
  • Phone: 870-935-6012
  • Fax: 870-934-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number111226
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE9760
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: