Provider Demographics
NPI:1992778559
Name:ANDERSON, SCOTT L (FNP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202D MCGILL AVE NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4615
Mailing Address - Country:US
Mailing Address - Phone:704-792-2242
Mailing Address - Fax:704-792-2272
Practice Address - Street 1:202D MCGILL AVE NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4615
Practice Address - Country:US
Practice Address - Phone:704-792-2242
Practice Address - Fax:704-792-2272
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP83295Medicaid
NCP83295Medicaid
NC2809720Medicare Oscar/Certification