Basic Information
| Provider Information | |||||||||
| NPI: | 1134116205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | FNP MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383512038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7319683646 | ||||||||
| FaxNumber: | 7319681807 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 W CHURCH ST STE A | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383512077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7319683646 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RN118564 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 7743 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1505103 | 05 | TN | MEDICAID | 4190376 | 01 | TN | BCBS | OTHER | 44002 | 01 | TN | TLC | OTHER | 56826600 | 01 | TN | US DEPT OF LABOR | OTHER | 3902350 | 05 | TN | MEDICAID |