Provider Demographics
NPI:1326387887
Name:SCOTT, LISA A (NP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:636-561-3021
Mailing Address - Fax:636-561-3022
Practice Address - Street 1:6261 RONALD REAGAN DR STE B19
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2665
Practice Address - Country:US
Practice Address - Phone:636-561-3021
Practice Address - Fax:636-561-3022
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012039956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily