Provider Demographics
NPI:1770398166
Name:NELSON, BETY MIRANDA (FNP-C)
Entity type:Individual
Prefix:
First Name:BETY
Middle Name:MIRANDA
Last Name:NELSON
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:BETY
Other - Middle Name:
Other - Last Name:NUNEZ MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4309 ONE MILE WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-6405
Mailing Address - Country:US
Mailing Address - Phone:704-493-6001
Mailing Address - Fax:
Practice Address - Street 1:1514 N GRAHAM ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-3022
Practice Address - Country:US
Practice Address - Phone:704-375-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021607363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care