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General NPI Number Information
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NPI Number | 1326387887
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Entity Type | Individual
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Provider Name | LISA A SCOTT NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 6261 RONALD REAGAN DR STE B19
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-2665
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Country | US
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Telephone | 636-561-3021
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Fax | 636-561-3022
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Provider Business Mailing Address
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Address Line | 670 MASON RIDGE CENTER DR STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8573
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Country | US
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Telephone | 636-561-3021
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Fax | 636-561-3022
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2012039956
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License Number State | MO
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