Provider Demographics
NPI:1124856265
Name:SCOTT, KERRY GRACE
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:GRACE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 RIVERSIDE PARK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5369
Mailing Address - Country:US
Mailing Address - Phone:307-349-7451
Mailing Address - Fax:
Practice Address - Street 1:409 RIVERSIDE PARK RD APT 3
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5369
Practice Address - Country:US
Practice Address - Phone:307-349-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant