Provider Demographics
NPI:1215349071
Name:SCOTT, JACQUELINE JOY (MSN, ARNP, CNM, WHNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JOY
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MSN, ARNP, CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15735 EIMICKE PL APT 409
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6690
Mailing Address - Country:US
Mailing Address - Phone:904-536-5857
Mailing Address - Fax:
Practice Address - Street 1:826 WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4072
Practice Address - Country:US
Practice Address - Phone:315-785-4624
Practice Address - Fax:315-785-4653
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN277195163WM0102X, 367A00000X
TX1001584367A00000X
NY002032367A00000X
WAAP60478195367A00000X
TX991007163WM0102X
NY805413163WM0102X
FLRN9254519163WM0102X
WARN00172280163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn