Individual
MR. DEREK M NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
810 N 22ND ST, BLAIR, NE 68008-1128
(402) 426-2182
(402) 426-1190
Mailing address
810 N 22ND ST, BLAIR, NE 68008-1128
(402) 426-2182
(402) 426-1190
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1126
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025300500
—
NE
05
—
10025355300
—
NE
01
—
12350231
CAQH
—
01
—
30694
BLUE CROSS
NE
Enumeration date
05/20/2006
Last updated
03/07/2023
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