Provider Demographics
NPI:1003971599
Name:SCOTT, TERI LYNAE (ARNP, CWCN)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:LYNAE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ARNP, CWCN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:SCOTT
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, CWCN
Mailing Address - Street 1:2520 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4229
Mailing Address - Country:US
Mailing Address - Phone:360-744-6610
Mailing Address - Fax:360-744-6141
Practice Address - Street 1:2520 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4229
Practice Address - Country:US
Practice Address - Phone:360-744-5618
Practice Address - Fax:360-744-4559
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007080363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8883372OtherPTAN
WAG8883373OtherPTAN
WAG8883372OtherPTAN