Provider Demographics
NPI:1174137046
Name:NELSON, MISTY EVE
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:EVE
Last Name:NELSON
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 1:3229 CAPON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HIGH VIEW
Mailing Address - State:WV
Mailing Address - Zip Code:26808-9767
Mailing Address - Country:US
Mailing Address - Phone:540-533-0906
Mailing Address - Fax:
Practice Address - Street 1:3229 CAPON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HIGH VIEW
Practice Address - State:WV
Practice Address - Zip Code:26808-9767
Practice Address - Country:US
Practice Address - Phone:540-533-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant