MEDICARE: NICCOLE MICHELE 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	172A00000X	Driver

General Provider Information

NPI Number	:	1992209910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICCOLE MICHELE SCOTT

Provider Business Mailing Address
First Line	:	4000 ROSE ST APT 2205
Second Line	:
City	:	CHALMETTE
State	:	LA
Zip	:	70043-2083
Country	:	US
Telephone Number	:	510-292-1067
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 N 44TH ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-1114
Country	:	US
Telephone Number	:	504-309-2045
Fax Number	:

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

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	03/23/2018

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Directions to “ NICCOLE MICHELE SCOTT ” Practice Location

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