Individual
MRS. MARCIA KATE SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
305 W JACKSON ST, SUITE 200, CARBONDALE, IL 62901-1474
(618) 536-6621
(618) 453-1102
Mailing address
300 W OAK ST, CARBONDALE, IL 62901-1400
(618) 536-6621
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085000735
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085000735
STATE LICENSE
IL
01
—
204683
HEALTH ALLIANCE
IL
05
—
370966854024
—
IL
01
—
CF3444
MEDICARE RR
IL
Enumeration date
04/07/2006
Last updated
12/09/2020
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