MEDICARE: JONEKIA D SCOTT

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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1609218189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONEKIA D SCOTT

Provider Business Mailing Address
First Line	:	1010 E ARKANSAS LN
Second Line	:	APT 50
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1363
Country	:	US
Telephone Number	:	214-907-6972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 E ARKANSAS LN
Second Line	:	APT 50
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1363
Country	:	US
Telephone Number	:	214-907-6972
Fax Number	:

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

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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