Provider Demographics
NPI:1477135267
Name:NELSON, CASEY PITTMAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:PITTMAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 WINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLAN
Mailing Address - State:MS
Mailing Address - Zip Code:38744
Mailing Address - Country:US
Mailing Address - Phone:662-822-4419
Mailing Address - Fax:
Practice Address - Street 1:984 WINGFIELD RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLAN
Practice Address - State:MS
Practice Address - Zip Code:38744-3874
Practice Address - Country:US
Practice Address - Phone:662-822-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904417363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care