Provider Demographics
NPI:1104466523
Name:SCOTT, SHENIQWA (APRN)
Entity type:Individual
Prefix:
First Name:SHENIQWA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7424 GREENVILLE AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4534
Mailing Address - Country:US
Mailing Address - Phone:214-363-2004
Mailing Address - Fax:214-234-0492
Practice Address - Street 1:5290 BELT LINE RD STE 134
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7512
Practice Address - Country:US
Practice Address - Phone:972-991-1424
Practice Address - Fax:972-991-1475
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2021-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX770276163W00000X
TX1015332363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse