Provider Demographics
NPI:1164837555
Name:NELSON, PAMELA (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E 15TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6238
Mailing Address - Country:US
Mailing Address - Phone:972-727-5471
Mailing Address - Fax:972-727-6239
Practice Address - Street 1:1201 E 15TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6238
Practice Address - Country:US
Practice Address - Phone:972-727-6239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX526317163WC1500X, 163W00000X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1932431764OtherNPI