Provider Demographics
NPI:1184038762
Name:NELSON, DANNY RAY (NP-C)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:RAY
Last Name:NELSON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2104
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-2104
Mailing Address - Country:US
Mailing Address - Phone:423-715-7224
Mailing Address - Fax:423-614-3033
Practice Address - Street 1:424 WYLOU DR NW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:TN
Practice Address - Zip Code:37310-5179
Practice Address - Country:US
Practice Address - Phone:423-715-7224
Practice Address - Fax:423-614-3033
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18752363LF0000X
TXAP127160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily