Healthcare Provider Details

I. General information

NPI: 1023896552
Provider Name (Legal Business Name): LINNESSA SUANNE SCOTT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

651 N INDIANA ST
MOORESVILLE IN
46158-1218
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-8148
  • Fax: 317-528-8115
Mailing address:
  • Phone: 317-506-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014544A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: