Provider Demographics
NPI:1154945178
Name:SCOTT, DANA J (PA-C)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W MAYFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-4596
Mailing Address - Country:US
Mailing Address - Phone:817-375-5847
Mailing Address - Fax:817-557-8094
Practice Address - Street 1:515 W MAYFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-4596
Practice Address - Country:US
Practice Address - Phone:817-375-5847
Practice Address - Fax:817-557-8094
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 390200000X
TXPA13909363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program