Individual
MATTHEW GLEN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
725 FAIR ST, BUHL, ID 83316-6442
(208) 543-8271
(208) 543-8272
Mailing address
794 EASTLAND DR, TWIN FALLS, ID 83301-6856
(208) 737-6718
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1267
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437584752
EMI HEALTH
UT
01
—
148464
PEHP
UT
01
—
5606757
AETNA HEALTHCARE
UT
01
—
P01239491
RAILROAD MEDICARE
UT
Enumeration date
09/05/2013
Last updated
03/17/2021
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