Basic Information
| Provider Information | |||||||||
| NPI: | 1295067643 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2431 W MAIN ST | ||||||||
| Address2: | 501 | ||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363011217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347939222 | ||||||||
| FaxNumber: | 3346710322 | ||||||||
| Practice Location | |||||||||
| Address1: | 2431 W MAIN ST | ||||||||
| Address2: | 501 | ||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363011217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347939222 | ||||||||
| FaxNumber: | 3346710322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2010 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA667 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.