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NPI Code Detail

MEDICARE: MR. ELISHA NELSON

MEDICARE: MR. ELISHA 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
1106S00000XBehavior TechnicianIN

General Provider Information

NPI Number : 1942010608
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ELISHA NELSON
Provider Business Mailing Address
First Line : 304 MARKET ST
Second Line :
City : EVANSVILLE
State : IN
Zip : 47708-1136
Country : US
Telephone Number : 615-604-5795
Fax Number :
Provider Business Practice Location Address
First Line : 5201 E VIRGINIA ST
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-2656
Country : US
Telephone Number : 812-436-1448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2025
Last Update Date : 03/16/2026

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