MEDICARE: TARA LEILA SCOTT PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61231851	WA
2	390200000X	Student in an Organized Health Care Education/Training Program	RN60636066	WA

General Provider Information

NPI Number	:	1386257491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA LEILA SCOTT PMHNP-BC

Provider Business Mailing Address
First Line	:	21727 76TH AVE W STE C
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7549
Country	:	US
Telephone Number	:	206-677-8167
Fax Number	:

Provider Business Practice Location Address
First Line	:	21727 76TH AVE W STE C
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7549
Country	:	US
Telephone Number	:	206-677-8167
Fax Number	:

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	03/13/2026

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