Brynna Scout Fullerton Vergara

Primary specialty

Clinical Pathology PhysicianTaxonomy code 207ZC0006X

License

SLPA14693 Issued in AZ

Practice address

101 S Airpark Rd
Cottonwood, AZ 86326-4182

Phone

(928) 639-2694

NPI assigned

Aug 2, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1003598608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 AIRPARK ROAD",
            "address_2": "SUITE M",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "86326",
            "telephone_number": "928-639-2694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S AIRPARK RD",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264182",
            "telephone_number": "928-639-2694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 S Airpark Rd Ste M",
            "address_purpose": "LOCATION",
            "city": "Cottonwood",
            "state": "AZ",
            "postal_code": "863264113",
            "country_code": "US",
            "telephone_number": "928-639-2694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERGARA",
        "first_name": "BRYNNA SCOUT",
        "middle_name": "FULLERTON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-02",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "AZ",
            "license": "SLPA14693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Verde Valley Occupational Therapy LLC
• Verde Valley Orthopedics PC
• Verde Valley Sedona Advanced Imaging Diagnostics LLC
• Verde Valley Urgent Care and Occupational Medicine, PLC
• Laurie Verdier, LPC
• Steven Vergara, D.D.S.
• Neeraj Vij, M.D.
• Ligia Villa
• Virginia Viol, LCSW
• Michael Peter Viotti, PSYCHOLOGIST

• Clinical Pathology Physician in Cottonwood, AZ
• Providers in Cottonwood, AZ by specialty
• Clinical Pathology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.