Provider Demographics
NPI:1972513422
Name:NELSON, AUSTIN T (PA)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:T
Last Name:NELSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 S 22ND DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8865
Mailing Address - Country:US
Mailing Address - Phone:928-343-0488
Mailing Address - Fax:928-782-0401
Practice Address - Street 1:2377 S 22ND DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8865
Practice Address - Country:US
Practice Address - Phone:928-343-0488
Practice Address - Fax:928-782-0401
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2244363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ102702Medicare PIN
AZP72857Medicare UPIN
AZ1176490003Medicare NSC