Provider Demographics
NPI:1730317561
Name:COMBS, SCOTTY DWAYNE (APRN)
Entity Type:Individual
Prefix:MR
First Name:SCOTTY
Middle Name:DWAYNE
Last Name:COMBS
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 1:141 MAIN ST
Mailing Address - Street 2:PO BOX 690
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-7484
Mailing Address - Country:US
Mailing Address - Phone:606-464-2401
Mailing Address - Fax:606-464-3290
Practice Address - Street 1:1484 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-6555
Practice Address - Country:US
Practice Address - Phone:606-666-9950
Practice Address - Fax:066-669-1366
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6068P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100126290Medicaid
KY3006068OtherAPRN LICENSURE
KY6068POtherARNP LICENSE #