Provider Demographics
NPI:1962504043
Name:SCOTT, PHYLLIS ANNE (MSN,CNS,APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:ANNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MSN,CNS,APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7352 PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7646
Mailing Address - Country:US
Mailing Address - Phone:317-272-1950
Mailing Address - Fax:
Practice Address - Street 1:110 W HONEY CREEK PKWY
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4114
Practice Address - Country:US
Practice Address - Phone:812-232-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002137A163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult