Provider Demographics
NPI:1205314531
Name:SCOTT, DEON QCUENISE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DEON
Middle Name:QCUENISE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DEON
Other - Middle Name:QCUENISE
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 WOODBROOK DR APT E106
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2681
Mailing Address - Country:US
Mailing Address - Phone:205-447-6704
Mailing Address - Fax:
Practice Address - Street 1:216 AQUARIUS DR STE 306
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5863
Practice Address - Country:US
Practice Address - Phone:205-949-0400
Practice Address - Fax:205-904-0405
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF07180129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5698932OtherDRIVERS LICENSE