Healthcare Provider Details

I. General information

NPI: 1083174700
Provider Name (Legal Business Name): BILLIE SCOTT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BILLIE JO SCOTT NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 S BROADWAY ST
MARLOW OK
73055-3885
US

IV. Provider business mailing address

1324 S BROADWAY ST
MARLOW OK
73055-3885
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-9100
  • Fax: 580-658-9104
Mailing address:
  • Phone: 580-658-9100
  • Fax: 580-658-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0062398
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: