Healthcare Provider Details

I. General information

NPI: 1306843990
Provider Name (Legal Business Name): DARRICK P. NELSON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N POPE ST
SILVER CITY NM
88061-5161
US

IV. Provider business mailing address

530 DEMOSS STREET
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1511
  • Fax: 575-388-3465
Mailing address:
  • Phone: 575-542-8384
  • Fax: 575-542-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL5071
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2010-0242
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: