Provider Demographics
NPI:1235140658
Name:SCOTT, KRISTIN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17230 JACKSON CREEK PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7301
Mailing Address - Country:US
Mailing Address - Phone:719-571-7000
Mailing Address - Fax:
Practice Address - Street 1:17230 JACKSON CREEK PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7301
Practice Address - Country:US
Practice Address - Phone:719-571-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-100529207Q00000X
CODR.0057632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH07402Medicare UPIN