Provider Demographics
NPI:1285663666
Name:SCOTT, KERRI (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:114A LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-4828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:ANESTHETICS OF WORCESTER, PC
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1200
Practice Address - Country:US
Practice Address - Phone:508-363-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217372367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA1056Medicare ID - Type UnspecifiedMASSACHUSETTS MEDICARE