Provider Demographics
NPI:1225782246
Name:SCOTT, MISTI LEE
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:LEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 N UNION ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1542
Mailing Address - Country:US
Mailing Address - Phone:580-749-4178
Mailing Address - Fax:
Practice Address - Street 1:1904 N UNION ST STE 103
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1542
Practice Address - Country:US
Practice Address - Phone:580-749-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist