Healthcare Provider Details

I. General information

NPI: 1174012355
Provider Name (Legal Business Name): ALEX L NIELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KIRKPATRICK FAMILY CARE 1706 WASHINGTON WAY
LONGVIEW WA
98632-2495
US

IV. Provider business mailing address

100 E 33RD ST STE 100
VANCOUVER WA
98663-2776
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-0390
  • Fax: 360-577-3865
Mailing address:
  • Phone: 360-514-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61130110
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61130110
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: