Provider Demographics
NPI:1114445400
Name:SCOTT, SHAUN MICHAEL (MSN APRN ACNPC-AG)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:MICHAEL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MSN APRN ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 CASTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0167
Mailing Address - Country:US
Mailing Address - Phone:972-523-7042
Mailing Address - Fax:
Practice Address - Street 1:1416 CASTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-0167
Practice Address - Country:US
Practice Address - Phone:972-523-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666112163WF0300X
TXAP143709363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WF0300XNursing Service ProvidersRegistered NurseFlight