Provider Demographics
NPI:1336282706
Name:NELSON, KAREN ELIZABETH (COMS)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:STRONG
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COMS
Mailing Address - Street 1:109 JACKSTAFF DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4104
Mailing Address - Country:US
Mailing Address - Phone:615-822-8206
Mailing Address - Fax:615-824-1463
Practice Address - Street 1:109 JACKSTAFF DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4104
Practice Address - Country:US
Practice Address - Phone:615-822-8206
Practice Address - Fax:615-824-1463
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225CX0006X
TNPTA0000002006225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00D65OtherPROVIDER NUMBER TN DMRS
TND65Medicaid