Provider Demographics
NPI:1215333752
Name:SCOTT, LATEISHA (NP)
Entity type:Individual
Prefix:
First Name:LATEISHA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2247
Mailing Address - Country:US
Mailing Address - Phone:251-949-3710
Mailing Address - Fax:251-949-3715
Practice Address - Street 1:1613 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2247
Practice Address - Country:US
Practice Address - Phone:251-949-3710
Practice Address - Fax:251-949-3715
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122964363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL168590Medicaid
KY7100679910Medicaid
MS00608511Medicaid
FL1215333752Medicaid