Provider Demographics
NPI:1659548402
Name:SCOTT, HOWARD KEITH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:KEITH
Last Name:SCOTT
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:5414 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1335
Practice Address - Country:US
Practice Address - Phone:903-581-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596797363LF0000X
TXAP116819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199313105Medicaid
TX75-2616977-002OtherTRICARE
TX75-1976930-005OtherTRICARE
TX75-0818167-022OtherTRICARE
TX75-0818167-044OtherTRICARE
TX75-2616977-001OtherTRICARE
TXP1587391OtherRAIL ROAD MEDICARE
TX75-0818167-015OtherTRICARE
TX75-0818167-048OtherTRICARE
TX75-2616977-028OtherTRICARE
TX199313104Medicaid
TXP01588043OtherRAIL ROAD MEDICARE
TXP1587393OtherRAIL ROAD MEDICARE
TX199313107Medicaid
TX465020YMAFMedicare PIN
TX75-0818167-022OtherTRICARE
TX199313107Medicaid
TX75-0818167-044OtherTRICARE