Healthcare Provider Details

I. General information

NPI: 1790433365
Provider Name (Legal Business Name): KATHERINE SCOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 KINGS HWY
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1335 BUCKHALL RD
BOSSIER CITY LA
71111-6240
US

V. Phone/Fax

Practice location:
  • Phone: 318-626-4300
  • Fax:
Mailing address:
  • Phone: 318-518-3268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number084192
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: