Provider Demographics
NPI:1912110123
Name:SCOTT, CHRISTOPHER LEE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E D ST
Mailing Address - Street 2:
Mailing Address - City:MUNDAY
Mailing Address - State:TX
Mailing Address - Zip Code:76371-1961
Mailing Address - Country:US
Mailing Address - Phone:940-422-5271
Mailing Address - Fax:940-422-4251
Practice Address - Street 1:131 SOUTH MUNDAY AVE
Practice Address - Street 2:
Practice Address - City:MUNDAY
Practice Address - State:TX
Practice Address - Zip Code:76371
Practice Address - Country:US
Practice Address - Phone:940-422-5271
Practice Address - Fax:940-422-4251
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX631651OtherFAMILY NURSE PRACTITIONER