Healthcare Provider Details

I. General information

NPI: 1841609633
Provider Name (Legal Business Name): NICOLE SCOTT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 MAIN ST
JASPER TN
37347-3438
US

IV. Provider business mailing address

110 REED RD
TRENTON GA
30752-5712
US

V. Phone/Fax

Practice location:
  • Phone: 423-651-1696
  • Fax: 423-651-1696
Mailing address:
  • Phone: 423-280-8086
  • Fax: 423-651-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18926
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN18926
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: