Provider Demographics
NPI:1083675268
Name:NELSON, LAURA KAY (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:KAY
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 N 18TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-3232
Mailing Address - Country:US
Mailing Address - Phone:602-364-4567
Mailing Address - Fax:602-364-4570
Practice Address - Street 1:150 N 18TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3232
Practice Address - Country:US
Practice Address - Phone:602-364-4567
Practice Address - Fax:602-364-4570
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ263162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2260OtherDEPARTMENT OF HEALTH SERV
AZ424482OtherAHCCCS ID