=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295537686
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOUT KETAMINE AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 COMMERCIAL DR STE B
-----------------------------------------------------
City | HARKER HEIGHTS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76548-2566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-251-3411
-----------------------------------------------------
Fax | 254-477-7080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1705 EDELWEISS DR
-----------------------------------------------------
City | CEDAR PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78613-3547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-213-1344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MRS. SHERRI SCOTT-HUNTER
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 559-213-1344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------