Provider Demographics
NPI:1467979229
Name:SCOTT, STACY RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:RENEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:RENEE
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534-1738
Mailing Address - Country:US
Mailing Address - Phone:785-285-0261
Mailing Address - Fax:
Practice Address - Street 1:311 MORROW ST N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-2516
Practice Address - Country:US
Practice Address - Phone:479-394-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily