Provider Demographics
NPI:1881843621
Name:NELSON, KELLEY N (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:N
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8316 KASEMAN CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7639
Mailing Address - Country:US
Mailing Address - Phone:505-292-5850
Mailing Address - Fax:505-292-9724
Practice Address - Street 1:8316 KASEMAN CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7639
Practice Address - Country:US
Practice Address - Phone:505-292-5850
Practice Address - Fax:505-292-9724
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-0041363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical