Active NPI
Jessica Scoville, CSFA
- Surgical Physician Assistant
- Kearney, NE
National Provider Identifier
1003397605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- Practice address
- 804 22ND Ave
Kearney, NE 68845-2206 - Phone
- (308) 440-1101
- NPI assigned
- Aug 22, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 40 | NE | |
| Surgical Physician Assistant | 363AS0400X | Primary |
Addresses
Primary practice location
804 22ND Ave
Kearney, NE 68845-2206
Mailing address
1710 Lincoln Ave
Cozad, NE 69130-1660
Phone (308) 440-1101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40 | NE | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536796800000",
"number": "1003397605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1710 LINCOLN AVE",
"city": "COZAD",
"state": "NE",
"postal_code": "691301660",
"telephone_number": "308-440-1101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "804 22ND AVE",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688452206",
"telephone_number": "308-440-1101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCOVILLE",
"first_name": "JESSICA",
"credential": "CSFA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-22",
"last_updated": "2018-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "NE",
"license": "40",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kearney, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.