Provider Demographics
NPI:1477748606
Name:SCOTT, VICKY KAY (NP)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:KAY
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17515 W 9 MILE RD STE 340
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4426
Mailing Address - Country:US
Mailing Address - Phone:248-569-2695
Mailing Address - Fax:248-569-7250
Practice Address - Street 1:17515 W 9 MILE RD STE 340
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4426
Practice Address - Country:US
Practice Address - Phone:248-569-2695
Practice Address - Fax:248-569-7250
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704179756363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N82760007OtherMEDICARE
MI500F318890OtherBCBSM
MI0N82770007OtherMEDICARE