Healthcare Provider Details

I. General information

NPI: 1073963187
Provider Name (Legal Business Name): OKSHOON SCOTT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 HART ST
CANTON MS
39046-4805
US

IV. Provider business mailing address

1171 HART ST
CANTON MS
39046-4805
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-9888
  • Fax: 601-859-9966
Mailing address:
  • Phone: 601-859-9888
  • Fax: 601-859-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901540
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: