Provider Demographics
NPI:1588996110
Name:SCOTT, VANESSA J (PA-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:J
Other - Last Name:GUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:902 W RANDOL MILL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2579
Mailing Address - Country:US
Mailing Address - Phone:817-801-1503
Mailing Address - Fax:817-801-1508
Practice Address - Street 1:902 W RANDOL MILL RD STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2579
Practice Address - Country:US
Practice Address - Phone:817-801-1503
Practice Address - Fax:817-801-1508
Is Sole Proprietor?:No
Enumeration Date:2010-02-07
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY557363AS0400X
AL363AS0400X
TX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
102I975958OtherMEDICARE
AL51112355OtherBLUE CROSS & BLUE SHIELD
MS07901322Medicaid
AL51112356OtherBLUE CROSS & BLUE SHIELD
AL126869Medicaid
AL126289Medicaid
AL126872Medicaid
AL126868Medicaid
AL51112353OtherBLUE CROSS & BLUE SHIELD
AL51112354OtherBLUE CROSS & BLUE SHIELD
AL51112356OtherBLUE CROSS & BLUE SHIELD