Healthcare Provider Details

I. General information

NPI: 1730110206
Provider Name (Legal Business Name): TROY MARVIN NELSON D.O.,PHARM.D.,M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 8TH ST
MAYFIELD KY
42066-2203
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 270-804-7710
  • Fax: 270-804-7722
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number02797KY
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02797
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: