Healthcare Provider Details

I. General information

NPI: 1174189153
Provider Name (Legal Business Name): REBECCA JO SCOTT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ALEXANDRIA PIKE STE 320
SOUTHGATE KY
41071-3243
US

IV. Provider business mailing address

29861 NETWORK PL
CHICAGO IL
60673-1298
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-1310
  • Fax: 859-572-3021
Mailing address:
  • Phone: 888-317-6934
  • Fax: 405-792-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: