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General NPI Number Information
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NPI Number | 1578598850
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Entity Type | Individual
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Provider Name | MCKENNETH SCOTT JR. PHYSICIANS ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 1750 TOMCAT BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23460-2168
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Country | US
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Telephone | 757-953-3933
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Fax | 757-953-3890
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Provider Business Mailing Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-3933
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Fax | 757-953-3890
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 006243
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License Number State | NY
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