Provider Demographics
NPI:1811001415
Name:SCOTT, JULIE L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M PA-C
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:208-342-1879
Practice Address - Street 1:2083 E HOSPITALITY LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-6603
Practice Address - Country:US
Practice Address - Phone:208-333-8345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-270363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDS93400Medicare UPIN
ID1666408Medicare PIN