Individual
SHAUN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
120 EXECUTIVE PARK, LOUISVILLE, KY 40207-4201
(502) 855-7200
(502) 855-7201
Mailing address
223 EXECUTIVE PARK, LOUISVILLE, KY 40207-4202
(502) 907-0356
(502) 919-9780
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA842
KY
Other
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
—
Enumeration date
09/12/2005
Last updated
04/14/2022
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