Provider Demographics
NPI:1811788904
Name:NELSON, KEVIN L (PEER SUPPORT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:NELSON
Suffix:
Gender:X
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 LENTZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1818
Mailing Address - Country:US
Mailing Address - Phone:502-762-6561
Mailing Address - Fax:
Practice Address - Street 1:3533 LENTZ AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1818
Practice Address - Country:US
Practice Address - Phone:502-762-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist