Provider Demographics
NPI:1457406100
Name:SCOTT, KELLY A (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 WINDOVER DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:PA
Mailing Address - Zip Code:15059-2216
Mailing Address - Country:US
Mailing Address - Phone:724-843-4010
Mailing Address - Fax:724-846-0588
Practice Address - Street 1:178 WINDOVER DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:PA
Practice Address - Zip Code:15059-2216
Practice Address - Country:US
Practice Address - Phone:724-843-4010
Practice Address - Fax:724-846-0588
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005628V363LW0102X, 363LP0808X
OH15562-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0116277Medicaid