Provider Demographics
NPI:1306220009
Name:NELSON, GUY WAYNE JR
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:WAYNE
Last Name:NELSON
Suffix:JR
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:PO BOX 8074
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-8074
Mailing Address - Country:US
Mailing Address - Phone:281-332-2626
Mailing Address - Fax:281-332-7272
Practice Address - Street 1:711 W BAY AREA BLVD STE 602
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4042
Practice Address - Country:US
Practice Address - Phone:281-332-2626
Practice Address - Fax:281-332-7272
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128206363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349317307Medicaid