Provider Demographics
NPI:1467803171
Name:NELSON, KIPP (MS, ATC)
Entity Type:Individual
Prefix:
First Name:KIPP
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S RANGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-4007
Mailing Address - Country:US
Mailing Address - Phone:785-460-5476
Mailing Address - Fax:
Practice Address - Street 1:1255 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-4007
Practice Address - Country:US
Practice Address - Phone:785-460-5476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer