Healthcare Provider Details

I. General information

NPI: 1659203131
Provider Name (Legal Business Name): MS. SHUNTAR LASEL SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 S CHERRY ST
PINE BLUFF AR
71603-5986
US

IV. Provider business mailing address

3318 S CHERRY ST
PINE BLUFF AR
71603-5986
US

V. Phone/Fax

Practice location:
  • Phone: 870-413-8057
  • Fax:
Mailing address:
  • Phone: 870-413-8057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number120696
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: