KELLY RAPHAEL NELSON (NPI# 1760435838) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1760435838 |
Entity Type | Individual |
Full Name | KELLY RAPHAEL NELSON |
Credential | MD |
Practice Address |
120 Medical Park Dr Suite 300 Bridgeport WV 26330-9012 |
Mailing Address |
120 Medical Park Dr Ste 300 Bridgeport WV 26330-9012 |
Practice Telephone | 3046247200 |
Mailing Telephone | 3046247200 |
Enumeration Date | 2006-05-18 |
Last Update Date | 2016-07-27 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207Q00000X | Family Medicine | 15120 | WV | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WV | 0041162000 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720639917 | Kelly Marie Nelson | Counselor | 205 Delway St Unit A, Raleigh, NC 27604-1131 | 2019-09-27 |
1669963344 | Kelly Nicole Nelson | Registered Nurse | 8800 Washington Ave Ste 200, Mount Pleasant, WI 53406 | 2018-05-29 |
1114301892 | Kelly Nelson | Speech-Language Pathologist | 847 N Marshfield Ave # 1f, Chicago, IL 60622-5132 | 2015-07-13 |
1508294000 | Kelly Caroline Nelson | Nurse Practitioner | 740 S Limestone Rm J442, Lexington, KY 40536-0001 | 2013-10-18 |
1417223371 | Kelly M Nelson | Social Worker | 11708 Wayzata Blvd, Minnetonka, MN 55305-2014 | 2012-03-26 |
1881826717 | Kelly Nelson | Occupational Therapist | 3124 Cambridge Cir, Allentown, PA 18104-2827 | 2009-08-11 |
1164682845 | Kelly Dyan Nelson | Developmental Therapist | 10606 Sycamore Grn, Louisville, KY 40223-2945 | 2008-06-16 |
1679638977 | Kelly Cobb Nelson | Occupational Therapist | 1203 Bombay Ln, Roswell, GA 30076-5822 | 2006-12-27 |
1265032643 | Kelly Nelson | Pharmacist | 10270 Front Beach Rd, Panama City Beach, FL 32407-3808 | 2020-10-27 |
1164081451 | Kelly Ann Nelson | Nurse Practitioner | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2019-06-10 |
Street Address |
120 MEDICAL PARK DR SUITE 300 |
City | BRIDGEPORT |
State | WV |
Zip Code | 26330-9012 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073500773 | Erin Colleen Hawkins | Nurse Practitioner | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2005-09-29 |
1992155097 | United Hospital Center, Inc. | Family Medicine | 120 Medical Park Dr, Ste 300, Bridgeport, WV 26330-9012 | 2016-06-20 |
1871998047 | Angotti Family Eyecare Pllc | Optometrist | 120 Medical Park Dr, Suite 104, Bridgeport, WV 26330-9012 | 2014-10-29 |
1144659574 | Melissa Minigh | Pharmacist | 120 Medical Park Dr, Suite 102, Bridgeport, WV 26330-9012 | 2013-11-06 |
1053553131 | Sharifeh Farasat | Dermatology | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2009-04-03 |
1114128634 | Frank Thomas Angotti IIi | Psychiatry & Neurology | 120 Medical Park Dr, United Summit Center - Frank Angotti Md, Bridgeport, WV 26330-9012 | 2007-05-31 |
1962520387 | Lori Michele Angotti | Optometrist | 120 Medical Park Dr, Suite 104, Bridgeport, WV 26330-9012 | 2007-03-26 |
1598822207 | Stephen Fuller Fryer | Family Medicine | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2007-01-02 |
1619067873 | Anthony Catania Jr. | Podiatrist | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2006-10-16 |
1891892097 | Mountain State Medical Specialties, Pllc | Physician Assistant | 120 Medical Park Dr, Suite 200, Bridgeport, WV 26330-9012 | 2006-09-20 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992303036 | Gage Mackenzie Chichester | Nurse Anesthetist, Certified Registered | 2673 Medical Park Drive, Bridgeport, WV 26330 | 2020-10-12 |
1851914105 | Melany Langhurst | Social Worker | 64 Professional Place, Suite 102, Bridgeport, WV 26330 | 2020-05-21 |
1245704980 | Adam Christopher Stonestreet | Social Worker | Community Care of Bridgeport, 65 Professional Place, Bridgeport, WV 26330 | 2019-01-16 |
1588146658 | Bridgeport Physical Therapy Services, Inc. | Occupational Therapist | 25 Sweetbrier Lane, Suite 105, Bridgeport, WV 26330 | 2018-09-05 |
1275040685 | White Oaks Assisted Living | Assisted Living Facility | 140 Professional Place White Oaks, Bridgeport, WV 26330 | 2018-01-08 |
1275049371 | Regional Eye Associates, Inc | Ophthalmology | 220 Southview Drive, Bridgeport, WV 26330 | 2017-12-27 |
1528586187 | Savanna Tamia Brown | Social Worker | 65 Professinal Place Suites 101,102103, Bridgeport, WV 26330 | 2017-09-05 |
1184079642 | Karla Kay Rinehart | Social Worker | 27 Trovato St., Suite 103, Bridgeport, WV 26330 | 2016-05-03 |
1396176756 | Willo Group LLC | Pharmacy | 460 E. Main Street, Bridgeport, WV 26330 | 2013-12-10 |
1891031878 | Sherri Michelle Dobson | Occupational Therapy Assistant | 1000 Maplewood Dr, Bridgeport, WV 26330 | 2012-12-20 |
Find all providers in zip 26330 |
Taxonomy Code | 207Q00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1780158287 | Rejuvenation Medspa | Family Medicine | 1400 Johnson Ave Ste 4a, Bridgeport, WV 26330-1063 | 2019-01-17 |
1497244321 | Sanitas of Connecticut LLC | Family Medicine | 4551 Main St, Bridgeport, CT 06606-1818 | 2018-05-07 |
1023471299 | Qmg4, LLC | Family Medicine | 4200 Main Street, Bridgeport, CT 06606 | 2016-04-04 |
1013395755 | Clinisanitas, PC | Family Medicine | 4543 Main St, Bridgeport, CT 06606-1818 | 2015-05-14 |
1982941431 | Razia Sultana Hashmi | Family Medicine | 115 Highland Ave, Bridgeport, CT 06604-3549 | 2013-01-03 |
1508025594 | Awais Malik | Family Medicine | 754 Clinton Ave, Bridgeport, CT 06604-2301 | 2008-06-04 |
1508062423 | Bridgeport Family Practice Obgyn Clinic | Family Medicine | 615 Kendall Ave, Bridgeport, AL 35740 | 2007-06-26 |
1760505887 | Vinai Montricul | Family Medicine | 47910 Al Highway 277, Bridgeport, AL 35740-7206 | 2007-04-06 |
1942341060 | Zijad Sabovic | Family Medicine | 3000 Park Ave, Bridgeport, CT 06604-1105 | 2007-02-09 |
1538207295 | Bridgeport Family Health LLC | Family Medicine | 1381 Reservoir Avenue, Bridgeport, CT 06606-2502 | 2007-02-02 |
Find all providers in BRIDGEPORT |
City | BRIDGEPORT |
Zip Code | 26330 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.