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NPI Code Detail

MEDICARE: KRISTIE NELSON PA

MEDICARE: KRISTIE NELSON PA
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
1363A00000XPhysician Assistant7220AZ
2363AS0400XSurgical Physician Assistant7220AZ
3363A00000XPhysician AssistantPA2025-0107NM

General Provider Information

NPI Number : 1881172526
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIE NELSON PA
Provider Business Mailing Address
First Line : PO BOX 80217
Second Line :
City : PHOENIX
State : AZ
Zip : 85060-0217
Country : US
Telephone Number : 602-385-2115
Fax Number : 480-418-3323
Provider Business Practice Location Address
First Line : 8405 N PIMA CENTER PKWY STE 101
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85258-4669
Country : US
Telephone Number : 602-648-5444
Fax Number : 602-772-3801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2018
Last Update Date : 02/16/2026

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Directions to “ KRISTIE NELSON PA” Practice Location

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