Basic Information
| Provider Information | |||||||||
| NPI: | 1093290496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | KUNWAL | ||||||||
| MiddleName: | MOLWANI | ||||||||
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| Credential: | DNP, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 SUN TEMPLE DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357588643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562883333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 600 SUN TEMPLE DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357588643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562883333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2018 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN216728 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LF0000X | 1-179662 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | F08180691 | 01 | GA | AMERICAN ASSOCIATION OF NURSE PRACTITIONERS | OTHER |