Provider Demographics
NPI:1063475309
Name:SCOTT, CHARLOTTE (PA)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 E STAN SCHLUETER LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-8352
Mailing Address - Country:US
Mailing Address - Phone:254-690-2800
Mailing Address - Fax:254-690-5401
Practice Address - Street 1:BLDG 2245, 58TH STREET AND 761ST TANK BATTALION AVENUE
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-0000
Practice Address - Country:US
Practice Address - Phone:254-287-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00269379OtherRR/MEDICARE
TX8N9121OtherBLUE SHIELD
TX8N9121OtherBLUE SHIELD
TXP00269379OtherRR/MEDICARE