Provider Demographics
NPI:1083027676
Name:SCOTT, SHENNA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHENNA
Middle Name:MARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-9202
Mailing Address - Country:US
Mailing Address - Phone:304-855-1200
Mailing Address - Fax:304-855-1230
Practice Address - Street 1:386 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-9202
Practice Address - Country:US
Practice Address - Phone:304-855-1200
Practice Address - Fax:304-855-1230
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV102688363LF0000X, 363LP0200X, 363LP0808X
KY3008677363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1083027676Medicaid