Provider Demographics
NPI:1780636613
Name:NELSON, KAY L (MD)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7551 YOUREE DR STE 11
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5533
Mailing Address - Country:US
Mailing Address - Phone:318-642-9282
Mailing Address - Fax:833-749-0340
Practice Address - Street 1:7551 YOUREE DR STE 11
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5533
Practice Address - Country:US
Practice Address - Phone:318-642-9282
Practice Address - Fax:833-749-0340
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA12198R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1695386Medicaid
LAG06287Medicare UPIN