Provider Demographics
NPI:1184457756
Name:SCOTT, SUZANNE N/A
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:N/A
Last Name:SCOTT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-6311
Mailing Address - Country:US
Mailing Address - Phone:662-299-7513
Mailing Address - Fax:
Practice Address - Street 1:507 AVENUE J
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-6311
Practice Address - Country:US
Practice Address - Phone:662-299-7513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2025-04-21
Deactivation Date:2024-09-23
Deactivation Code:
Reactivation Date:2025-04-21
Provider Licenses
StateLicense IDTaxonomies
MS26752376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide