Provider Demographics
NPI:1942564299
Name:SCOTT, JESSICA ROSE (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ROSE
Other - Last Name:REIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:172 WOODBINE BY THE LK
Mailing Address - Street 2:UNIT 2
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-7860
Mailing Address - Country:US
Mailing Address - Phone:518-569-7742
Mailing Address - Fax:
Practice Address - Street 1:206 CORNELIA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2779
Practice Address - Country:US
Practice Address - Phone:518-562-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4210831363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03486202Medicaid