Provider Demographics
NPI:1396116109
Name:SCOTT, KELLEY
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SUMMIT AVE
Mailing Address - Street 2:MSO PHYSICIAN BILLING
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7597
Mailing Address - Fax:740-283-7608
Practice Address - Street 1:1800 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1949
Practice Address - Country:US
Practice Address - Phone:740-537-3898
Practice Address - Fax:740-537-3956
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18383363LF0000X
WVAPRN72576-FNP-BC363LF0000X
PASP015720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0149336Medicaid
WVWV6209AMedicare PIN
OH0149336Medicaid
PA463668YGC9Medicare PIN