Provider Demographics
NPI:1699091728
Name:GREENWOOD, SCOTT N (NP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:N
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W RANDOL MILL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2581
Mailing Address - Country:US
Mailing Address - Phone:817-417-9334
Mailing Address - Fax:817-417-9339
Practice Address - Street 1:902 W RANDOL MILL RD STE 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2581
Practice Address - Country:US
Practice Address - Phone:817-417-9334
Practice Address - Fax:817-417-9339
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213226801Medicaid
TX213226803Medicaid
TX213226802Medicaid
TX213226801Medicaid
TX213226802Medicaid
TX213226803Medicaid