Provider Demographics
NPI:1194118067
Name:NELSON, RICHARD ARNO
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ARNO
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2764
Mailing Address - Country:US
Mailing Address - Phone:931-762-1918
Mailing Address - Fax:931-762-1918
Practice Address - Street 1:715 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2764
Practice Address - Country:US
Practice Address - Phone:931-762-1918
Practice Address - Fax:931-762-1918
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN374892085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3790308Medicaid
TN3790308Medicare PIN