=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235357211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA GAYLE SCOTT CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 10/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8307 KNIGHT RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-3905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-242-7707
-----------------------------------------------------
Fax | 713-243-3276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1614 BUCKINGHAM DR
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77504-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-770-8645
-----------------------------------------------------
Fax | 281-998-0497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 608059
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------