Provider Demographics
NPI:1235587171
Name:NELSON, DEBRA (CNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:K
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:7370 W RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3695
Mailing Address - Country:US
Mailing Address - Phone:201-658-0423
Mailing Address - Fax:
Practice Address - Street 1:7370 W RIDGE CIR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3695
Practice Address - Country:US
Practice Address - Phone:201-658-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004740363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health