Healthcare Provider Details

I. General information

NPI: 1083027676
Provider Name (Legal Business Name): SHENNA MARIE SCOTT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 AIRPORT RD
CHAPMANVILLE WV
25508-9202
US

IV. Provider business mailing address

386 AIRPORT RD
CHAPMANVILLE WV
25508-9202
US

V. Phone/Fax

Practice location:
  • Phone: 304-855-1200
  • Fax: 304-855-1230
Mailing address:
  • Phone: 304-855-1200
  • Fax: 304-855-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number102688
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008677
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3008677
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number102688
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number102688
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: