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General NPI Number Information
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NPI Number | 1326716879
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Entity Type | Individual
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Provider Name | EMILY IONE NELSON PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 2728 W MALLARD CREEK CHURCH RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28262-2309
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Country | US
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Telephone | 980-218-1860
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Fax | 704-548-8437
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Provider Business Mailing Address
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Address Line | 2728 W MALLARD CREEK CHURCH RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28262-2309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA14606
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-14010
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License Number State | NC
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