Healthcare Provider Details

I. General information

NPI: 1164137022
Provider Name (Legal Business Name): JAMES W NELSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 TRICORN RD
DANVILLE WV
25053-7148
US

IV. Provider business mailing address

PO BOX 222
TURTLE CREEK WV
25203-0222
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1385
  • Fax:
Mailing address:
  • Phone: 681-278-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number97696
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: