Healthcare Provider Details

I. General information

NPI: 1518970334
Provider Name (Legal Business Name): CELESTE M NELSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W MAIN ST
LEXINGTON SC
29072-2507
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-358-6100
  • Fax: 803-358-6105
Mailing address:
  • Phone: 803-358-6100
  • Fax: 803-358-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number309003003
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC109051
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number24879
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: