Provider Demographics
NPI:1639918246
Name:SCOTT, SHANNON MICHELLE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
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 1:941 W PEACH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-3853
Mailing Address - Country:US
Mailing Address - Phone:580-641-1680
Mailing Address - Fax:
Practice Address - Street 1:941 W PEACH AVE STE 2
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-3853
Practice Address - Country:US
Practice Address - Phone:580-641-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemaker