Provider Demographics
NPI:1104889427
Name:SCOTT, SUSAN CAROL (CRNA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2224
Mailing Address - Country:US
Mailing Address - Phone:270-393-2137
Mailing Address - Fax:
Practice Address - Street 1:902 ELM ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2224
Practice Address - Country:US
Practice Address - Phone:270-393-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1100968367500000X
NC050687367500000X
SCR57654367500000X
MER044418367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1275815Medicaid
KY3398239Medicare ID - Type Unspecified
KY1275815Medicaid