Provider Demographics
NPI:1780403915
Name:SCOTT, RAGNAR (NP)
Entity type:Individual
Prefix:
First Name:RAGNAR
Middle Name:
Last Name:SCOTT
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E EVERGREEN BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3264
Mailing Address - Country:US
Mailing Address - Phone:509-596-1138
Mailing Address - Fax:971-308-7811
Practice Address - Street 1:400 E EVERGREEN BLVD STE 217
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3264
Practice Address - Country:US
Practice Address - Phone:509-596-1138
Practice Address - Fax:971-308-7811
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10034127363LP0808X
WAAP61615356363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty