Healthcare Provider Details

I. General information

NPI: 1306635396
Provider Name (Legal Business Name): JENNIFER C SCOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 CAMDEN DR APT C
HOUSTON TX
77021-1156
US

IV. Provider business mailing address

2346 CAMDEN DR APT C
HOUSTON TX
77021-1156
US

V. Phone/Fax

Practice location:
  • Phone: 443-978-9008
  • Fax:
Mailing address:
  • Phone: 443-978-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95272754
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1177016
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1177016
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number95272754
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number1177016
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number95272754
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1177016
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: