Provider Demographics
NPI:1730110206
Name:NELSON, TROY MARVIN (DO,PHARMD,MPH)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:MARVIN
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO,PHARMD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:
Practice Address - Street 1:211 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2203
Practice Address - Country:US
Practice Address - Phone:270-804-7710
Practice Address - Fax:270-804-7722
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02797207R00000X
KY02797KY261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64071806Medicaid
KY00428Medicare PIN
KYK026710Medicare PIN
KYH89795Medicare UPIN
KY64071806Medicaid