Provider Demographics
NPI:1316023385
Name:NELSON, KEVIN GREGRORY (FNP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:GREGRORY
Last Name:NELSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8327 BRIMHALL RD STE 704
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2250
Mailing Address - Country:US
Mailing Address - Phone:661-829-7677
Mailing Address - Fax:661-679-6920
Practice Address - Street 1:8327 BRIMHALL RD STE 704
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2250
Practice Address - Country:US
Practice Address - Phone:661-829-7677
Practice Address - Fax:661-679-6920
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF8183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN336575OtherRN LIC#
CAPA13727OtherPHYSICIAN ASST LIC. #
CAPA13727OtherPHYSICIAN ASST LIC. #