MEDICARE: MR. SHAUN MICHAEL SCOTT MSN APRN ACNPC-AG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WF0300X	Flight Registered Nurse	666112	TX
2	363LA2100X	Acute Care Nurse Practitioner	AP143709	TX

General Provider Information

NPI Number	:	1114445400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAUN MICHAEL SCOTT MSN APRN ACNPC-AG

Provider Business Mailing Address
First Line	:	1416 CASTLE CREEK DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-0167
Country	:	US
Telephone Number	:	972-523-7042
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 CASTLE CREEK DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-0167
Country	:	US
Telephone Number	:	972-523-7042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	07/21/2022

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