Provider Demographics
NPI:1922187715
Name:NELSON, SUSAN KAY (CNM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 NEAL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0944
Mailing Address - Country:US
Mailing Address - Phone:931-520-1529
Mailing Address - Fax:931-372-2751
Practice Address - Street 1:1080 NEAL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0944
Practice Address - Country:US
Practice Address - Phone:931-520-1529
Practice Address - Fax:931-372-2751
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN15448367A00000X
MO2006032072367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006032072OtherRN, MIDWIFE LICENSE