Provider Demographics
NPI:1942852157
Name:SCOTT, ANNA GAYLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:GAYLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3574 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3044
Mailing Address - Country:US
Mailing Address - Phone:803-796-2500
Mailing Address - Fax:803-796-4378
Practice Address - Street 1:3574 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3044
Practice Address - Country:US
Practice Address - Phone:037-962-5008
Practice Address - Fax:803-796-4378
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2519363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical