Provider Demographics
NPI:1598816126
Name:NELSON, JOSHUA DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DAVID
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23351 PRAIRIE STAR PKWY STE A275
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-7302
Mailing Address - Country:US
Mailing Address - Phone:913-722-1222
Mailing Address - Fax:833-596-2340
Practice Address - Street 1:23401 PRAIRIE STAR PKWY STE B230
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7268
Practice Address - Country:US
Practice Address - Phone:913-722-1222
Practice Address - Fax:833-596-2340
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-06251207X00000X
MO2011007292207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1598816126Medicaid
MOMA4170114Medicare UPIN