Individual
KYLE K NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1520 WHITEHALL RD, ANDERSON, SC 29625-1916
(864) 512-5984
(864) 512-7586
Mailing address
PO BOX 100174, COLUMBIA, SC 29202-3174
(864) 512-5984
(864) 512-7586
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00647
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006479
—
SC
01
—
DF4920
RR MEDICARE
SC
Enumeration date
05/15/2006
Last updated
11/23/2022
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