Provider Demographics
NPI:1700074648
Name:NELSON, TEAK ERIN (MS, RN-CS, CFNP)
Entity Type:Individual
Prefix:
First Name:TEAK
Middle Name:ERIN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, RN-CS, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 NORTH BALTIMORE ST
Mailing Address - Street 2:PO BOX 763
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501
Mailing Address - Country:US
Mailing Address - Phone:660-665-5672
Mailing Address - Fax:660-665-1626
Practice Address - Street 1:2002 NORTH BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501
Practice Address - Country:US
Practice Address - Phone:660-665-5672
Practice Address - Fax:660-665-1626
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS91798Medicare UPIN