Individual
DR. KELLY K NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
21 HIGHLAND AVE SE, SUITE 100, ROANOKE, VA 24013-2201
(540) 344-9213
(540) 345-7559
Mailing address
5625 JONAMAC PL, APT. 3A, ROANOKE, VA 24019-6126
(540) 977-2714
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
0101238648
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126F1
BLUE CROSS
—
05
—
89126F1
—
NC
Enumeration date
08/31/2005
Last updated
11/12/2020
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