Basic Information
| Provider Information | |||||||||
| NPI: | 1235357211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | GAYLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1614 BUCKINGHAM DR | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817708645 | ||||||||
| FaxNumber: | 2819980497 | ||||||||
| Practice Location | |||||||||
| Address1: | 8307 KNIGHT RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770543905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132427707 | ||||||||
| FaxNumber: | 7132433276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 608059 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 608059 | 01 | TX | RN | OTHER |