Provider Demographics
NPI:1144225988
Name:NELSON, SCOTT KIMBERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KIMBERLY
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 OLD HAMMOND HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8264
Mailing Address - Country:US
Mailing Address - Phone:225-923-0960
Mailing Address - Fax:225-923-3736
Practice Address - Street 1:10423 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8264
Practice Address - Country:US
Practice Address - Phone:225-923-0960
Practice Address - Fax:225-923-3736
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018972207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1398233Medicaid
LA1398233Medicaid
LA5M067Medicare ID - Type Unspecified