Provider Demographics
NPI:1609226737
Name:NILSSON, KODY JAMES I (MD)
Entity Type:Individual
Prefix:DR
First Name:KODY
Middle Name:JAMES
Last Name:NILSSON
Suffix:I
Gender:M
Credentials:MD
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Mailing Address - Street 1:1664 S DIXIE DR
Mailing Address - Street 2:STE D102
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7329
Mailing Address - Country:US
Mailing Address - Phone:435-656-2995
Mailing Address - Fax:435-656-3237
Practice Address - Street 1:1664 S DIXIE DR
Practice Address - Street 2:STE D102
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7329
Practice Address - Country:US
Practice Address - Phone:435-656-2995
Practice Address - Fax:435-656-3237
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2019-08-07
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Provider Licenses
StateLicense IDTaxonomies
UT112799561205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine