Provider Demographics
NPI:1790319945
Name:NELSON, ARIALE MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ARIALE
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WESTBROOK ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482-5048
Mailing Address - Country:US
Mailing Address - Phone:601-408-6296
Mailing Address - Fax:
Practice Address - Street 1:2255 BROADWAY DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3254
Practice Address - Country:US
Practice Address - Phone:601-288-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily