Provider Demographics
NPI:1508203621
Name:SCOTT, JACQUELINE ANN (FNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7398 YONI LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5973
Mailing Address - Country:US
Mailing Address - Phone:901-382-4798
Mailing Address - Fax:
Practice Address - Street 1:2500 PERES AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38108-1660
Practice Address - Country:US
Practice Address - Phone:901-515-5500
Practice Address - Fax:901-458-5591
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91168163W00000X
TN17496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse