Provider Demographics
NPI:1134586720
Name:SCOTT, RICHARD GARRETT (AGNP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GARRETT
Last Name:SCOTT
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:504 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6917
Mailing Address - Country:US
Mailing Address - Phone:805-739-3474
Mailing Address - Fax:805-346-3548
Practice Address - Street 1:1510 E MAIN ST
Practice Address - Street 2:SUITE 104C
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4825
Practice Address - Country:US
Practice Address - Phone:805-349-8514
Practice Address - Fax:805-349-8958
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60822207363LG0600X
CANP95003596363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology