Provider Demographics
NPI:1093078040
Name:SCOTT, KRISTA RENEE
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:RENEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 GHOLSON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2321
Mailing Address - Country:US
Mailing Address - Phone:513-633-4052
Mailing Address - Fax:
Practice Address - Street 1:669 GHOLSON AVE APT 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2321
Practice Address - Country:US
Practice Address - Phone:513-633-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-23
Last Update Date:2012-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH119264164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse