Individual
KENNETH E NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
9600657
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
9600657
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1032U
BCBS
NC
01
—
19627
PARTNERS
NC
05
—
3810001343
—
WV
01
—
5124538
AETNA
—
05
—
5716047
—
VA
01
—
72411
MEDCOST
NC
05
—
891032U
—
NC
Enumeration date
12/13/2005
Last updated
09/08/2017
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