Healthcare Provider Details

I. General information

NPI: 1548896962
Provider Name (Legal Business Name): KATRINA LEANN SCOTT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 CRESTWOOD CIR
MENA AR
71953-5513
US

IV. Provider business mailing address

1102 CRESTWOOD CIR
MENA AR
71953-5513
US

V. Phone/Fax

Practice location:
  • Phone: 479-234-4433
  • Fax: 479-234-4445
Mailing address:
  • Phone: 479-234-4433
  • Fax: 479-234-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number124327
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: