Provider Demographics
NPI:1124505219
Name:NELSON, THERESA JOAN (FNP-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:JOAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 ANDREW JACKSON HWY SW
Mailing Address - Street 2:
Mailing Address - City:CERRO GORDO
Mailing Address - State:NC
Mailing Address - Zip Code:28430-9258
Mailing Address - Country:US
Mailing Address - Phone:910-654-2050
Mailing Address - Fax:
Practice Address - Street 1:805 S MADISON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4613
Practice Address - Country:US
Practice Address - Phone:910-642-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily