Healthcare Provider Details

I. General information

NPI: 1497787741
Provider Name (Legal Business Name): STEPHEN LEWIS NELSON JR. MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 S I-1-10 SERVICE RD SUITE 401
METARIE LA
70001
US

IV. Provider business mailing address

1415 TULANE AVE ROOM 6809
NEW ORLEANS LA
70112-2600
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-9235
  • Fax: 504-988-7654
Mailing address:
  • Phone: 504-988-6751
  • Fax: 504-988-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71165
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number201697
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number201697
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number19921
License Number StateMS
# 5
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number201697
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: