Provider Demographics
NPI:1467692962
Name:SCOTT, CAROLYN LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LOUISE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:NATURITA
Mailing Address - State:CO
Mailing Address - Zip Code:81422-0340
Mailing Address - Country:US
Mailing Address - Phone:970-865-2665
Mailing Address - Fax:970-865-2674
Practice Address - Street 1:421 ADAMS ST
Practice Address - Street 2:
Practice Address - City:NATURITA
Practice Address - State:CO
Practice Address - Zip Code:81422-5018
Practice Address - Country:US
Practice Address - Phone:970-865-2665
Practice Address - Fax:970-865-2674
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT324648-1206207PE0004X
COPA.0002217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP02143Medicare UPIN