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General NPI Number Information
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NPI Number | 1730352972
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Entity Type | Organization
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Legal Business Name | BLUEGRASS PAIN CONSULTANTS PLLC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 10241 CHAMPION FARMS DR
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City | LOUISVILLE
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State | KY
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Zip | 40241-6150
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Country | US
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Telephone | 502-423-1021
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Fax | 502-423-1416
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Provider Business Mailing Address
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Address Line | 10301 CHAMPION FARMS DRIVE
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City | LOUISVILLE
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State | KY
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Zip | 40241-6129
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Country | US
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Telephone | 502-423-1021
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Fax | 502-423-1416
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER L. NELSON
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Credential |
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Telephone | 502-423-1021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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