Provider Demographics
NPI:1508938572
Name:TROY M NELSON DO PHARMD MPH PSC
Entity Type:Organization
Organization Name:TROY M NELSON DO PHARMD MPH PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO,PHARMD,MPH
Authorized Official - Phone:270-443-0708
Mailing Address - Street 1:125 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7100
Mailing Address - Country:US
Mailing Address - Phone:270-443-0708
Mailing Address - Fax:270-443-0705
Practice Address - Street 1:125 SOUTH 20TH ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7100
Practice Address - Country:US
Practice Address - Phone:270-443-0708
Practice Address - Fax:270-443-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02797261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64071806Medicaid
KY64071806Medicaid
KYH89795Medicare UPIN