Basic Information
| Provider Information | |||||||||
| NPI: | 1336174697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 FIRST AVENUE | ||||||||
| Address2: | ROOM 1022 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045268958 | ||||||||
| FaxNumber: | 3043997579 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 FIRST AVE FIRST FLOOR | ||||||||
| Address2: | THE CENTER FOR PAIN RELIEF TRI STATE PLLC | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045268384 | ||||||||
| FaxNumber: | 3045261951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 09/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 00575 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 203735494 | 01 | WV | TAX ID# | OTHER | 61007300 | 01 | WV | AETNA | OTHER |