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General NPI Number Information
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NPI Number | 1598158271
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Entity Type | Individual
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Provider Name | KELLY JO NELSON APN, FNP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 260 ARSENAL PLACE
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City | WATERTOWN
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State | MA
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Zip | 02472-4054
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Country | US
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Telephone | 888-897-1887
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Fax | 857-343-8192
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Provider Business Mailing Address
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Address Line | 10121 PINE AVE
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City | TRUCKEE
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State | CA
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Zip | 96161-4856
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Country | US
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Telephone | 530-587-6022
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2368035
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95025001
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209012197
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License Number State | IL
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