Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0216030 | OH |
NPI | 1013420801 |
---|---|
Provider Name | Kelly Marie Scott |
First Address | Willoughby Hills, OH 44094-9019 |
Second Address | Willoughby Hills, OH 44094-9019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2017 |
Last Update Date | 15/11/2017 |