Provider Demographics
NPI:1013694991
Name:NELSEN, ANNA KATHRYN
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHRYN
Last Name:NELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PEPPERMINT LN
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9210
Mailing Address - Country:US
Mailing Address - Phone:317-853-9382
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST UNIVERSITY
Practice Address - Street 2:PO BOX 7329
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27109
Practice Address - Country:US
Practice Address - Phone:336-758-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer