MEDICARE: MS. KRISTA CHANTAL NELSON FNP

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	363LF0000X	Family Nurse Practitioner	887031	NV

General Provider Information

NPI Number	:	1669277513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTA CHANTAL NELSON FNP

Provider Business Mailing Address
First Line	:	1809 SIERRA OAKS LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 N NELLIS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-6743
Country	:	US
Telephone Number	:	702-227-4040
Fax Number	:

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

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	02/14/2025

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