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General NPI Number Information
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NPI Number | 1417213489
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Entity Type | Individual
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Provider Name | VICKI R NELSON MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 200 PATEWOOD DR STE C100
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City | GREENVILLE
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State | SC
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Zip | 29615-6322
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Country | US
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Telephone | 864-454-7422
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Fax | 864-454-8265
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8611
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.126659
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | LL39824
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39824
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License Number State | SC
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