Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | C-6140 | AR |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | C-6140 | AR |
NPI | 1447239702 |
---|---|
Provider Name | Stephen B. Nelson |
First Address | Van Buren, AR 72956-8810 |
Second Address | Fort Smith, AR 72903-4100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 27/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100079750A | (05) | OK |
102075001 | (05) | AR |
53897 | BLUECROSS BLUESHIELD (01) | AR |
D04825 | (02) |