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Individual
MR. MICHAEL SCOTT NELSON
Active
Individual
MR. MICHAEL SCOTT NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04398
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083727986
TRICARE SOUTH
TX
05
—
187788801
—
TX
05
—
187788802
—
TX
01
—
8Y0711
BCBSTX PROVIDER NO
TX
Enumeration date
08/16/2006
Last updated
10/23/2018
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