Healthcare Provider Details

I. General information

NPI: 1821330168
Provider Name (Legal Business Name): KURT LINDSLEY NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PEGRAM DR
TUPELO MS
38801-6322
US

IV. Provider business mailing address

PO BOX 2180
TUPELO MS
38803-2180
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-6513
  • Fax:
Mailing address:
  • Phone: 662-844-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25415
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: