Individual
RICHARD GORDON NELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
104 HEIGHTS RD # R103, DARIEN, CT 06820-4119
(888) 663-6331
(415) 252-7176
Mailing address
20449 KOGLIN RD, HUTCHINSON, MN 55350-4332
(612) 327-2732
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005341
CT
363AM0700X
Medical Physician Assistant
027096
NY
363AM0700X
Medical Physician Assistant
10468
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1082853
NCCPA
—
Enumeration date
05/28/2008
Last updated
01/26/2026
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