Provider Demographics
NPI:1619200615
Name:SEMONES, SCOTT EDDY (NP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:EDDY
Last Name:SEMONES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-2379
Mailing Address - Country:US
Mailing Address - Phone:970-874-2753
Mailing Address - Fax:970-874-2943
Practice Address - Street 1:360 E 8TH ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2379
Practice Address - Country:US
Practice Address - Phone:970-874-2753
Practice Address - Fax:970-874-2943
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSNP-20006363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57281289Medicaid