Provider Demographics
NPI:1730654534
Name:SCOTT, KAYTIE PHYLLIS (PA-S)
Entity Type:Individual
Prefix:MRS
First Name:KAYTIE
Middle Name:PHYLLIS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:KAYTIE
Other - Middle Name:PHYLLIS
Other - Last Name:THORPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1269 E 3075 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1887
Mailing Address - Country:US
Mailing Address - Phone:801-710-3313
Mailing Address - Fax:
Practice Address - Street 1:1269 E 3075 N
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-1887
Practice Address - Country:US
Practice Address - Phone:801-710-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6645931-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant