Provider Demographics
NPI:1558389841
Name:SCOTT, GARY ALLEN (FNP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALLEN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1546
Mailing Address - Country:US
Mailing Address - Phone:805-772-1506
Mailing Address - Fax:
Practice Address - Street 1:2280 SUNSET DR
Practice Address - Street 2:SUITE D
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-4007
Practice Address - Country:US
Practice Address - Phone:805-528-0650
Practice Address - Fax:805-528-1690
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 320903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily