Provider Demographics
NPI:1538978416
Name:SCOTT, TIFFANY R (ST/68W)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ST/68W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 POLLOCK PL
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-7148
Mailing Address - Country:US
Mailing Address - Phone:504-301-5155
Mailing Address - Fax:
Practice Address - Street 1:417 POLLOCK PL
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7148
Practice Address - Country:US
Practice Address - Phone:504-301-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171000000X
225A00000X, 343900000X, 251E00000X
GA246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No171000000XOther Service ProvidersMilitary Health Care Provider
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)