Provider Demographics
NPI:1215349071
Name:SCOTT, JACQUELINE JOY (DNP, ARNP, CNM, WHNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JOY
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DNP, ARNP, CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 ABRAHAM DR APT B
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-7203
Mailing Address - Country:US
Mailing Address - Phone:904-536-5857
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CENTER RD
Practice Address - Street 2:BLDG 36065
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8109
Practice Address - Fax:254-288-8093
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001584363LX0001X, 367A00000X
GARN227195363LX0001X
WARN00172280163WM0102X
FLRN9254519163WM0102X
GARN277195163WM0102X, 367A00000X
NY002032363LX0001X, 367A00000X
WAAP60478195363LX0001X, 367A00000X
TX991007163WM0102X
NY805413163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn