Provider Demographics
NPI:1376861799
Name:NELSON, ENOLA MARIE (PA PHD)
Entity Type:Individual
Prefix:MRS
First Name:ENOLA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA PHD
Other - Prefix:
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Mailing Address - Street 1:100 SE 4TH STREET
Mailing Address - Street 2:BOX 33
Mailing Address - City:KERENS
Mailing Address - State:TX
Mailing Address - Zip Code:75144-0033
Mailing Address - Country:US
Mailing Address - Phone:972-449-3555
Mailing Address - Fax:972-449-3344
Practice Address - Street 1:100 SE 4TH STREET
Practice Address - Street 2:
Practice Address - City:KERENS
Practice Address - State:TX
Practice Address - Zip Code:75144-0033
Practice Address - Country:US
Practice Address - Phone:972-449-3555
Practice Address - Fax:972-449-3344
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01033363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026259Medicare UPIN
TXFC6824Medicare Oscar/Certification