MEDICARE: KAYLEE E NELSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1336095983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEE E NELSON

Provider Business Mailing Address
First Line	:	1414 WESTWAY DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-8128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 WESTWAY DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-8128
Country	:	US
Telephone Number	:	843-478-5561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ KAYLEE E NELSON ” Practice Location

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