Healthcare Provider Details

I. General information

NPI: 1467648204
Provider Name (Legal Business Name): JESSICA R NELSEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 18TH ST SE
HICKORY NC
28602-1363
US

IV. Provider business mailing address

895 STATE FARM RD SUITE 303
BOONE NC
28607-4917
US

V. Phone/Fax

Practice location:
  • Phone: 828-485-2160
  • Fax:
Mailing address:
  • Phone: 828-264-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP11215
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: