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NPI Code Detail

MEDICARE: CHARLA JEAN NELSON

MEDICARE:   CHARLA JEAN NELSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse1110597KY
2163W00000XRegistered Nurse354822OH

General Provider Information

NPI Number : 1568195733
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLA JEAN NELSON
Provider Business Mailing Address
First Line : 201 CRESTVIEW RD
Second Line :
City : RUSSELL
State : KY
Zip : 41169-1462
Country : US
Telephone Number : 606-571-1732
Fax Number :
Provider Business Practice Location Address
First Line : 332 15TH ST
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7626
Country : US
Telephone Number : 606-420-0204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2022
Last Update Date : 07/06/2022

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Directions to “ CHARLA JEAN NELSON ” Practice Location

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