Healthcare Provider Details

I. General information

NPI: 1407228794
Provider Name (Legal Business Name): TAMARA SCOTT RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MEDICINE WAY ROAD
PERIDOT AZ
85542
US

IV. Provider business mailing address

103 MEDICINE WAY ROAD
PERIDOT AZ
85542
US

V. Phone/Fax

Practice location:
  • Phone: 928-475-1343
  • Fax:
Mailing address:
  • Phone: 928-475-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: