Provider Demographics
NPI:1548896962
Name:SCOTT, KATRINA LEANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LEANN
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 1:1102 CRESTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-5513
Mailing Address - Country:US
Mailing Address - Phone:479-234-4433
Mailing Address - Fax:479-234-4445
Practice Address - Street 1:1102 CRESTWOOD CIR
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-5513
Practice Address - Country:US
Practice Address - Phone:479-234-4433
Practice Address - Fax:479-234-4445
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily