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General NPI Number Information
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NPI Number | 1417991423
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Entity Type | Individual
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Provider Name | SCOTT EDWARD WITHERS NP
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 9900 BREN RD E
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 972-310-7339
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Fax |
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Provider Business Mailing Address
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Address Line | 102 KELVINGTON DR
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City | ANNA
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State | TX
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Zip | 75409-0056
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Country | US
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Telephone | 972-310-7339
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Fax |
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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 | AP110973
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 648384
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License Number State | TX
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