MEDICARE: DR. LATORA GRANT SCOTT PHD, RN

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	163W00000X	Registered Nurse	695349	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	695349	OTHER	TX	TEXAS BOARD OF NURSING

General Provider Information

NPI Number	:	1205173374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATORA GRANT SCOTT PHD, RN

Provider Business Mailing Address
First Line	:	523 REBECCA DR
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-3061
Country	:	US
Telephone Number	:	469-516-2686
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 REBECCA DR
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-3061
Country	:	US
Telephone Number	:	469-516-2686
Fax Number	:

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

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	12/01/2020

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