Provider Demographics
NPI:1891369245
Name:SCOTT, ZACHARY LEE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LEE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-7504
Mailing Address - Country:US
Mailing Address - Phone:620-515-0555
Mailing Address - Fax:918-273-5416
Practice Address - Street 1:237 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-3660
Practice Address - Country:US
Practice Address - Phone:918-273-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily