Provider Demographics
NPI:1639867336
Name:SCOTT, KRISTIAN T
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:T
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4019
Mailing Address - Country:US
Mailing Address - Phone:571-344-8696
Mailing Address - Fax:
Practice Address - Street 1:1507 FREEDOM WAY SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3101
Practice Address - Country:US
Practice Address - Phone:202-856-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant