Provider Demographics
NPI:1750323788
Name:SCOTT, SUSAN L (PA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 E CAMP WISDOM RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-2828
Mailing Address - Country:US
Mailing Address - Phone:214-217-0303
Mailing Address - Fax:214-217-0304
Practice Address - Street 1:814 E CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-2828
Practice Address - Country:US
Practice Address - Phone:142-217-0303
Practice Address - Fax:214-217-0304
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8936787OtherWA CRIME VICTIM
7570SCOtherREGENCE BS
0191713OtherWA L & I
WA8405854Medicaid
0191713OtherWA L & I
S82284Medicare UPIN