Basic Information
| Provider Information | |||||||||
| NPI: | 1497787741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | LEWIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 TULANE AVE | ||||||||
| Address2: | ROOM 6809 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049886751 | ||||||||
| FaxNumber: | 5049882568 | ||||||||
| Practice Location | |||||||||
| Address1: | 4720 S I-1-10 SERVICE RD SUITE 401 | ||||||||
| Address2: | |||||||||
| City: | METARIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049889235 | ||||||||
| FaxNumber: | 5049887654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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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 | 208000000X | 71165 | MD | N | Allopathic & Osteopathic Physicians | Pediatrics | 2084N0402X | 201697 | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | 2084N0402X | 19921 | MS | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1021075 | 05 | LA | MEDICAID | 00A845150 | 05 | CA | MEDICAID |