Provider Demographics
NPI:1174960140
Name:NELSON, NEELY FRANK (SFIDC)
Entity type:Individual
Prefix:
First Name:NEELY
Middle Name:FRANK
Last Name:NELSON
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC BOX 8023
Mailing Address - Street 2:BLDG. 4389
Mailing Address - City:CHERRY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28533-0023
Mailing Address - Country:US
Mailing Address - Phone:252-466-0396
Mailing Address - Fax:
Practice Address - Street 1:504 COMPANY D STREET
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0042
Practice Address - Country:US
Practice Address - Phone:910-450-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman