Individual
KELLY RAPHAEL NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 MEDICAL PARK DR, SUITE 300, BRIDGEPORT, WV 26330-9012
(304) 624-7200
Mailing address
120 MEDICAL PARK DR, STE 300, BRIDGEPORT, WV 26330-9012
(304) 624-7200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15120
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0041162000
—
WV
Enumeration date
05/18/2006
Last updated
01/13/2021
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