Provider Demographics
NPI:1952952459
Name:SCOTT, CHANTHA PRAK (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CHANTHA
Middle Name:PRAK
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-6199
Mailing Address - Fax:336-718-6190
Practice Address - Street 1:725 HIGHLAND OAKS DR STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7109
Practice Address - Country:US
Practice Address - Phone:336-718-6199
Practice Address - Fax:336-718-6190
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019045719363LF0000X
NC5012328363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily