Provider Demographics
NPI:1184724007
Name:NELSON, KATHRYN S (ARNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:NELSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 11TH ST SW
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-5849
Mailing Address - Country:US
Mailing Address - Phone:712-580-4570
Mailing Address - Fax:712-580-4573
Practice Address - Street 1:337 11TH ST SW
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-5849
Practice Address - Country:US
Practice Address - Phone:712-580-4570
Practice Address - Fax:712-580-4573
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-056987363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA056987OtherIA NURSING LICENSE
IA1184724007Medicaid
IAA-056987OtherARNP LICENSE
IAA-056987OtherARNP LICENSE