Provider Demographics
NPI:1609330794
Name:SCOTT, MELODY LYNETTE (CMF)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:LYNETTE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 EVANGELINE WALK
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5475
Mailing Address - Country:US
Mailing Address - Phone:318-294-0049
Mailing Address - Fax:318-746-1533
Practice Address - Street 1:223 EVANGELINE WALK
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5475
Practice Address - Country:US
Practice Address - Phone:318-294-0049
Practice Address - Fax:318-746-1533
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC53163224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter