Provider Demographics
NPI:1083174700
Name:SCOTT, BILLIE JO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:JO
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-3885
Mailing Address - Country:US
Mailing Address - Phone:580-658-9100
Mailing Address - Fax:580-658-9104
Practice Address - Street 1:1324 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-3885
Practice Address - Country:US
Practice Address - Phone:580-658-9100
Practice Address - Fax:580-658-9104
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily