Provider Demographics
NPI:1871242388
Name:PRESCOTT, SHAYLA SIERRA (NP)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:SIERRA
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 ANGORA ALY
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-2201
Mailing Address - Country:US
Mailing Address - Phone:404-909-2712
Mailing Address - Fax:
Practice Address - Street 1:2311 HENRY CLOWER BLVD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7418
Practice Address - Country:US
Practice Address - Phone:470-306-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily