Provider Demographics
NPI:1518734185
Name:PERRY, SCOTT TIMOTHY (CRNP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:TIMOTHY
Last Name:PERRY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32-36 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1899
Mailing Address - Country:US
Mailing Address - Phone:570-724-1631
Mailing Address - Fax:570-724-2126
Practice Address - Street 1:32-36 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1899
Practice Address - Country:US
Practice Address - Phone:570-724-1631
Practice Address - Fax:570-724-2126
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily