Provider Demographics
NPI:1154481224
Name:SCOTT, LINDSEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 ALVIN RICKEN DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2727
Mailing Address - Country:US
Mailing Address - Phone:208-233-9080
Mailing Address - Fax:208-478-9297
Practice Address - Street 1:1901 ALVIN RICKEN DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2727
Practice Address - Country:US
Practice Address - Phone:208-233-9080
Practice Address - Fax:208-478-9297
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP52092Medicare UPIN
IDPA18691Medicare ID - Type Unspecified