MEDICARE: MRS. KAYTIE PHYLLIS SCOTT PA-S

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	363A00000X	Physician Assistant	6645931-1206	UT

General Provider Information

NPI Number	:	1730654534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYTIE PHYLLIS SCOTT PA-S

Provider Business Mailing Address
First Line	:	1269 E 3075 N
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-1887
Country	:	US
Telephone Number	:	801-710-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1269 E 3075 N
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-1887
Country	:	US
Telephone Number	:	801-710-3313
Fax Number	:

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

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	11/15/2019

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