Provider Demographics
NPI:1508959479
Name:NELSON, CAROL JEAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 NW CR 2171
Mailing Address - Street 2:
Mailing Address - City:BARRY
Mailing Address - State:TX
Mailing Address - Zip Code:75102
Mailing Address - Country:US
Mailing Address - Phone:903-229-7367
Mailing Address - Fax:
Practice Address - Street 1:100 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-3702
Practice Address - Country:US
Practice Address - Phone:903-713-1511
Practice Address - Fax:903-713-1519
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02477207PE0004X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133367605Medicaid
TX133367605Medicaid
TX453977Medicare PIN