Healthcare Provider Details

I. General information

NPI: 1487011383
Provider Name (Legal Business Name): KASSANDRA ROSE SCOTT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSANDRA R EPPERSON NP

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 40TH AVE
PINE BLUFF AR
71603-6301
US

IV. Provider business mailing address

1600 W 40TH AVE
PINE BLUFF AR
71603-6301
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-7111
  • Fax:
Mailing address:
  • Phone: 870-541-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004633
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: