Provider Demographics
NPI:1902510712
Name:SCOTT, TRICIA LYNNE
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 PRIDE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-6094
Mailing Address - Country:US
Mailing Address - Phone:681-404-8325
Mailing Address - Fax:
Practice Address - Street 1:917 PRIDE RIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-6094
Practice Address - Country:US
Practice Address - Phone:681-404-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV63395163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice