# SHAUN NELSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1104811603
- **Gender:** F
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA842 | KY | Yes |

## Other

- **Enumeration date:** 09/12/2005
- **Last updated:** 04/14/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000001408313 | ANTHEM PROVIDER ID NUMBER | — |
| 01 | — | 100508KYIP | AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER | KY |
| 01 | — | 2268718 | WELLCARE OF KY PROVIDER ID NUMBER | KY |
| 05 | — | 300040820 | — | IN |
| 05 | — | 95004735 | — | KY |
| 01 | — | CS2026900168 | CARESOURCE PROVIDER ID NUMBER | — |