Individual
DR. STEPHEN MICHAEL NELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(812) 629-0614
Mailing address
200 W CHURCH ST, LEXINGTON, TN 38351-2038
(731) 968-3646
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4954
TN
207Q00000X
Family Medicine Physician
Primary
0000004954
TN
207R00000X
Internal Medicine Physician
4954
TN
208000000X
Pediatrics Physician
4954
TN
208100000X
Physical Medicine & Rehabilitation Physician
4954
TN
2085R0202X
Diagnostic Radiology Physician
4954
TN
208600000X
Surgery Physician
4954
TN
Other
Enumeration date
06/04/2019
Last updated
05/22/2025
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