Provider Demographics
NPI:1659832426
Name:SCOTT, DEVIN JAMES (APRN)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:JAMES
Last Name:SCOTT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79135 SUMNER RD
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-6106
Mailing Address - Country:US
Mailing Address - Phone:308-627-0130
Mailing Address - Fax:
Practice Address - Street 1:3533 PRAIRIEVIEW ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4409
Practice Address - Country:US
Practice Address - Phone:308-675-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113954363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner