Provider Demographics
NPI:1093189540
Name:SCOTT, JENNY (FNP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:R
Other - Last Name:CROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:13570 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2012
Mailing Address - Country:US
Mailing Address - Phone:706-956-2665
Mailing Address - Fax:706-657-2958
Practice Address - Street 1:13570 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2012
Practice Address - Country:US
Practice Address - Phone:706-956-2665
Practice Address - Fax:706-657-2958
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000173250363LF0000X
GARN253824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily