Provider Demographics
NPI:1386055176
Name:SCOTT, SERINA (LAC)
Entity type:Individual
Prefix:MS
First Name:SERINA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2314
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37816-2314
Mailing Address - Country:US
Mailing Address - Phone:423-736-2089
Mailing Address - Fax:
Practice Address - Street 1:400 E ECONOMY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3388
Practice Address - Country:US
Practice Address - Phone:423-736-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACU 35171100000X
CAAC 6566171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist