Provider Demographics
NPI:1720256266
Name:SCOTT, KELLEY VIRGINIA (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:VIRGINIA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:VIRGINIA
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1171 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2505
Mailing Address - Country:US
Mailing Address - Phone:515-280-7004
Mailing Address - Fax:515-280-9525
Practice Address - Street 1:1007 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4495
Practice Address - Country:US
Practice Address - Phone:918-587-1101
Practice Address - Fax:918-587-0589
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK87451364SW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200132800AMedicaid