Healthcare Provider Details

I. General information

NPI: 1336641570
Provider Name (Legal Business Name): JENNIFER LYNN SCOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 03/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S BALLENGER HWY
FLINT MI
48532-3638
US

IV. Provider business mailing address

9338 ASPEN VIEW DR
GRAND BLANC MI
48439-8081
US

V. Phone/Fax

Practice location:
  • Phone: 810-342-2000
  • Fax:
Mailing address:
  • Phone: 810-241-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704206784
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: