Individual
LARRY DEAN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1001 BLYTHE BLVD STE 300, CHARLOTTE, NC 28203-5863
(704) 373-0212
(704) 373-1216
Mailing address
PO BOX 60122, CHARLOTTE, NC 28260-0122
(704) 373-0212
(704) 373-1216
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
101010
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0194PA
—
SC
01
—
P00245252
RAILROAD MEDICARE
—
Enumeration date
08/18/2006
Last updated
12/28/2007
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