Provider Demographics
NPI:1568596476
Name:SCOTT, AUDREY F (RD,LD, CDE)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:F
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RD,LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 BETHEL REED PARK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1818
Mailing Address - Country:US
Mailing Address - Phone:614-447-9495
Mailing Address - Fax:614-447-9163
Practice Address - Street 1:5202 BETHEL REED PARK
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1818
Practice Address - Country:US
Practice Address - Phone:614-447-9495
Practice Address - Fax:614-447-9163
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH864720133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH376730Medicare PIN