Provider Demographics
NPI:1073852968
Name:NELSON, KEVIN WAYNE
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:WAYNE
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 WINTHROP PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5746
Mailing Address - Country:US
Mailing Address - Phone:702-434-8242
Mailing Address - Fax:
Practice Address - Street 1:446 WINTHROP PL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5746
Practice Address - Country:US
Practice Address - Phone:702-434-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner