Provider Demographics
NPI:1336174697
Name:NELSON, STEVEN F (PA C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:F
Last Name:NELSON
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FIRST AVENUE
Mailing Address - Street 2:ROOM 1022
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1241
Mailing Address - Country:US
Mailing Address - Phone:304-526-8958
Mailing Address - Fax:304-399-7579
Practice Address - Street 1:2900 FIRST AVE FIRST FLOOR
Practice Address - Street 2:THE CENTER FOR PAIN RELIEF TRI STATE PLLC
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702
Practice Address - Country:US
Practice Address - Phone:304-526-8384
Practice Address - Fax:304-526-1951
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00575363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV203735494OtherTAX ID#
WV61007300OtherAETNA
WV203735494OtherTAX ID#
S65296Medicare UPIN
WVPA12543Medicare ID - Type Unspecified