Healthcare Provider Details

I. General information

NPI: 1760749154
Provider Name (Legal Business Name): JOHN DALEY NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 HILL COUNTRY DR
KERRVILLE TX
78028
US

IV. Provider business mailing address

575 HILL COUNTRY DR
KERRVILLE TX
78028-6024
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-7762
  • Fax: 830-258-7098
Mailing address:
  • Phone: 830-258-7762
  • Fax: 830-258-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR4292
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: