Healthcare Provider Details

I. General information

NPI: 1770004319
Provider Name (Legal Business Name): KAYLEE ANN NELSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 MICA DR STE 201
CARSON CITY NV
89705-7258
US

IV. Provider business mailing address

555 N ARLINGTON AVE
RENO NV
89503-4723
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-8800
  • Fax: 775-348-8818
Mailing address:
  • Phone: 775-786-3040
  • Fax: 775-786-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1860
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1860
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: