Healthcare Provider Details

I. General information

NPI: 1538079389
Provider Name (Legal Business Name): KATRINA A SCOTT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-2047 26TH AVE
KEAAU HI
96749
US

IV. Provider business mailing address

HC 3 BOX 13090
KEAAU HI
96749-9222
US

V. Phone/Fax

Practice location:
  • Phone: 808-271-5566
  • Fax:
Mailing address:
  • Phone: 808-271-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN-20235-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: