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General NPI Number Information
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NPI Number | 1639945108
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Entity Type | Individual
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Provider Name | KYLE MATHEW SCOTT
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Gender | Male
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 11277 VERNON PL STE 200
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City | MEADVILLE
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State | PA
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Zip | 16335-3719
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Country | US
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Telephone | 814-724-1252
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Fax | 814-333-8871
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Provider Business Mailing Address
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Address Line | 1518 HENDERSONVILLE ROAD
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City | SANDY LAKE
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State | PA
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Zip | 16145
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Country | US
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Telephone | 724-851-1303
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP028625
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP028625
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License Number State | PA
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