Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN 1-105883 | AL |
N | 363LC1500X | Nurse Practitioner - Community Health | RN 1 105883 | AL |
NPI | 1427315746 |
---|---|
Provider Name | Ms. Letisha S Scott |
First Address | Tuscaloosa, AL 35401-5235 |
Second Address | Tuscaloosa, AL 35401-5235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 12/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN 1-105883 | RN LICENSE NUMBER (01) | AL |