Provider Demographics
NPI:1255322442
Name:SCOTT, MICHAEL PRESTON (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PRESTON
Last Name:SCOTT
Suffix:
Gender:M
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 1:10001 S EASTERN AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3907
Mailing Address - Country:US
Mailing Address - Phone:702-269-6345
Mailing Address - Fax:702-269-9422
Practice Address - Street 1:10001 S EASTERN AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3907
Practice Address - Country:US
Practice Address - Phone:702-269-6345
Practice Address - Fax:702-269-9422
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA755363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
O38689Medicare UPIN
NV100372Medicare ID - Type Unspecified