Provider Demographics
NPI:1740645779
Name:SCOTT, KIMBERLY (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 AVENUE T
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4604
Mailing Address - Country:US
Mailing Address - Phone:718-755-5353
Mailing Address - Fax:
Practice Address - Street 1:5207 AVENUE T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4604
Practice Address - Country:US
Practice Address - Phone:718-755-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5452911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5452911OtherREGISTERED NURSE