Healthcare Provider Details

I. General information

NPI: 1346931953
Provider Name (Legal Business Name): SHARI LYNN SCOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARI LYNN KSOBIECH

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 LAKE BOONE TRL
RALEIGH NC
27607-0115
US

IV. Provider business mailing address

1748 HERITAGE CENTER DR STE 101
WAKE FOREST NC
27587-9855
US

V. Phone/Fax

Practice location:
  • Phone: 984-230-2416
  • Fax: 984-220-9339
Mailing address:
  • Phone: 919-899-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number157172
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5018130
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: