Healthcare Provider Details

I. General information

NPI: 1467979229
Provider Name (Legal Business Name): STACY RENEE SCOTT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY RENEE GRIMM

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 EUCLID AVE
HORTON KS
66439-1238
US

IV. Provider business mailing address

800 RAVENHILL DR
ATCHISON KS
66002-9204
US

V. Phone/Fax

Practice location:
  • Phone: 785-486-2468
  • Fax: 785-486-2371
Mailing address:
  • Phone: 913-367-2131
  • Fax: 913-674-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77803
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: