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NPI Code Detail

MEDICARE: BETY MIRANDA NELSON FNP-C

MEDICARE: BETY MIRANDA NELSON FNP-C
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
1363LP2300XPrimary Care Nurse Practitioner5021607NC

General Provider Information

NPI Number : 1770398166
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETY MIRANDA NELSON FNP-C
Provider Business Mailing Address
First Line : 4309 ONE MILE WAY
Second Line :
City : CHARLOTTE
State : NC
Zip : 28215-6405
Country : US
Telephone Number : 704-493-6001
Fax Number :
Provider Business Practice Location Address
First Line : 1514 N GRAHAM ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28206-3022
Country : US
Telephone Number : 704-375-0172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2025
Last Update Date : 02/18/2025

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