Provider Demographics
NPI:1336574565
Name:AVERY, SCOTT E (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:AVERY
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21493 TITUS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-4352
Mailing Address - Country:US
Mailing Address - Phone:904-654-2680
Mailing Address - Fax:
Practice Address - Street 1:1001 CENTERBROOKE LN STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8663
Practice Address - Country:US
Practice Address - Phone:757-702-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171326363LA2100X
VA0001247949363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care