Healthcare Provider Details

I. General information

NPI: 1174573422
Provider Name (Legal Business Name): KIRK LEE NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD # 116A MCGUIRE VAMC
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

5041 SOUTHMOOR RD
RICHMOND VA
23234-3753
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-6737
  • Fax: 804-675-6736
Mailing address:
  • Phone: 804-675-6737
  • Fax: 804-675-6736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101040453
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number0101040453
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: