MEDICARE: LISA A SCOTT NP-C

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	363LF0000X	Family Nurse Practitioner	2012039956	MO

General Provider Information

NPI Number	:	1326387887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA A SCOTT NP-C

Provider Business Mailing Address
First Line	:	670 MASON RIDGE CENTER DR
Second Line	:	STE 300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8573
Country	:	US
Telephone Number	:	636-561-3021
Fax Number	:	636-561-3022

Provider Business Practice Location Address
First Line	:	6261 RONALD REAGAN DR STE B19
Second Line	:
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-2665
Country	:	US
Telephone Number	:	636-561-3021
Fax Number	:	636-561-3022

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/12/2021

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