Provider Demographics
NPI:1689370694
Name:SCOTT, OCTAVIA STRIBLING (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:STRIBLING
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5496 WISTERIA TRCE
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-6316
Mailing Address - Country:US
Mailing Address - Phone:205-490-5228
Mailing Address - Fax:
Practice Address - Street 1:1189 ALLBRITTON RD
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-2663
Practice Address - Country:US
Practice Address - Phone:205-946-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-144137363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner