Provider Demographics
NPI:1205591294
Name:SCOTT, CHRISTOPHER DAVID (APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:SCOTT
Suffix:
Gender:M
Credentials:APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 MOCKINGBIRD ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2236
Mailing Address - Country:US
Mailing Address - Phone:972-275-9630
Mailing Address - Fax:
Practice Address - Street 1:908 N ROCKFORD RD STE A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2541
Practice Address - Country:US
Practice Address - Phone:580-223-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112079363LA2100X
TX913790163WA2000X, 163W00000X
OK1112079363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse