Provider Demographics
NPI:1538110978
Name:SCOTTEN, MITZI S (MD)
Entity Type:Individual
Prefix:DR
First Name:MITZI
Middle Name:S
Last Name:SCOTTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CHURCH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4112
Mailing Address - Country:US
Mailing Address - Phone:870-935-6012
Mailing Address - Fax:870-934-3156
Practice Address - Street 1:800 S CHURCH ST STE 400
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4112
Practice Address - Country:US
Practice Address - Phone:870-935-6012
Practice Address - Fax:870-934-3156
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111226208000000X
ARE9760208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR213090001Medicaid
MO208888206Medicaid
MO208888206Medicaid
AR213090001Medicaid