Healthcare Provider Details

I. General information

NPI: 1912267295
Provider Name (Legal Business Name): MRS. AMBER LYNN SCOUTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST
PETERSON AFB CO
80914-1541
US

IV. Provider business mailing address

559 VINCENT ST
PETERSON AFB CO
80914-1541
US

V. Phone/Fax

Practice location:
  • Phone: 719-556-5552
  • Fax:
Mailing address:
  • Phone: 719-556-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number1912267295
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: