Provider Demographics
NPI:1831716646
Name:NELSON, ARTHUR JEFFERY (PA-C)
Entity type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:JEFFERY
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 1:17550 PROVOST ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5199
Mailing Address - Country:US
Mailing Address - Phone:503-872-2440
Mailing Address - Fax:503-513-3355
Practice Address - Street 1:17550 PROVOST ST STE 201
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-5199
Practice Address - Country:US
Practice Address - Phone:503-872-2440
Practice Address - Fax:503-513-3355
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA201757363A00000X
WAPA61111935363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500787098Medicaid