Provider Demographics
NPI:1215382783
Name:SCOTT, KATHLEEN DOLPHIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DOLPHIN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:BEHM
Other - Last Name:DOLPHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:Q10-1, UROLOGY DEPARTMENT
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:Q10-1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-636-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004622RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant