Provider Demographics
NPI:1033105473
Name:NELSON, GREGORY W (FNP-C, DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:NELSON
Suffix:
Gender:M
Credentials:FNP-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 THOUSAND OAKS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4108
Mailing Address - Country:US
Mailing Address - Phone:210-348-6377
Mailing Address - Fax:
Practice Address - Street 1:55 GRUENE PARK DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2459
Practice Address - Country:US
Practice Address - Phone:830-379-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6736111NS0005X
TX774561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU59568Medicare UPIN