Provider Demographics
NPI:1275419319
Name:NELSON, KALYSA MONIQUE (RN, BSN, DNP, FNP)
Entity type:Individual
Prefix:MRS
First Name:KALYSA
Middle Name:MONIQUE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN, BSN, DNP, FNP
Other - Prefix:MS
Other - First Name:KALYSA
Other - Middle Name:
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12035 WAYBURN ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1037
Mailing Address - Country:US
Mailing Address - Phone:313-717-2552
Mailing Address - Fax:
Practice Address - Street 1:12035 WAYBURN ST
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48224-1037
Practice Address - Country:US
Practice Address - Phone:313-717-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704364066163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse