Healthcare Provider Details

I. General information

NPI: 1255369674
Provider Name (Legal Business Name): MS. CHRIS A NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 HIGHWAY 190 EAST SERVICE RD SUITE 200
COVINGTON LA
70433-4960
US

IV. Provider business mailing address

PO BOX 129
MADISONVILLE LA
70447-0129
US

V. Phone/Fax

Practice location:
  • Phone: 985-234-3000
  • Fax: 985-234-3002
Mailing address:
  • Phone: 985-234-3000
  • Fax: 985-234-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: