Healthcare Provider Details

I. General information

NPI: 1679282693
Provider Name (Legal Business Name): MICHAEL D SCOTT JR. NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W SUNSHINE ST
SPRINGFIELD MO
65807-2240
US

IV. Provider business mailing address

1900 W SUNSHINE ST
SPRINGFIELD MO
65807-2240
US

V. Phone/Fax

Practice location:
  • Phone: 417-241-1043
  • Fax:
Mailing address:
  • Phone: 417-241-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2020002483
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: