Provider Demographics
NPI:1336779941
Name:SCOTT, KIMBERLY NICHOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICHOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8232
Mailing Address - Country:US
Mailing Address - Phone:863-528-5627
Mailing Address - Fax:
Practice Address - Street 1:201 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-8232
Practice Address - Country:US
Practice Address - Phone:863-528-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily