Healthcare Provider Details

I. General information

NPI: 1164041513
Provider Name (Legal Business Name): DOROTHY LEE SCOTT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 NW 5TH ST
STIGLER OK
74462-1611
US

IV. Provider business mailing address

907 NW 5TH ST
STIGLER OK
74462-1611
US

V. Phone/Fax

Practice location:
  • Phone: 918-967-0055
  • Fax: 918-967-2808
Mailing address:
  • Phone: 918-967-0055
  • Fax: 918-967-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03200634
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: