Healthcare Provider Details

I. General information

NPI: 1578354767
Provider Name (Legal Business Name): JESSICA RAE GREEN SCOTT MA, RN, CIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOSPITAL DR
COLUMBIA MO
65201-5275
US

IV. Provider business mailing address

509 ROCKHILL RD
COLUMBIA MO
65201-5901
US

V. Phone/Fax

Practice location:
  • Phone: 573-355-6071
  • Fax:
Mailing address:
  • Phone: 573-355-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number2018023182
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: