Provider Demographics
NPI:1801190673
Name:SCOTT, KRISTIN JEAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:JEAN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:JEAN
Other - Last Name:JAMIESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:43 SACHEM ST
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-5106
Mailing Address - Country:US
Mailing Address - Phone:978-985-9265
Mailing Address - Fax:
Practice Address - Street 1:106 HANOVER ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1008
Practice Address - Country:US
Practice Address - Phone:603-448-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0807363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical