Provider Demographics
NPI:1205206067
Name:SCOTT, AKEEM JAMAL (CRNA)
Entity Type:Individual
Prefix:
First Name:AKEEM
Middle Name:JAMAL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 POPLAR ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3709
Mailing Address - Country:US
Mailing Address - Phone:215-416-1624
Mailing Address - Fax:
Practice Address - Street 1:78 POPLAR ST
Practice Address - Street 2:APT. 1
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3709
Practice Address - Country:US
Practice Address - Phone:215-416-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN604983367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered