Healthcare Provider Details

I. General information

NPI: 1497695498
Provider Name (Legal Business Name): VICTOR NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 GLEN MEADOW ST
HOT SPRINGS AR
71901-8116
US

IV. Provider business mailing address

104 GLEN MEADOW ST
HOT SPRINGS AR
71901-8116
US

V. Phone/Fax

Practice location:
  • Phone: 501-276-9642
  • Fax:
Mailing address:
  • Phone: 501-276-9642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: