Provider Demographics
NPI:1205484128
Name:SCOTT, RACHEL DEANN (LPN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DEANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-0662
Mailing Address - Country:US
Mailing Address - Phone:405-527-1785
Mailing Address - Fax:
Practice Address - Street 1:314 S BROADWAY AVE STE 106
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5818
Practice Address - Country:US
Practice Address - Phone:580-235-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54461164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse