Provider Demographics
NPI:1194987289
Name:NELSON, KYLE SHAUNE (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:SHAUNE
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11850 BLACKFOOT ST NW
Mailing Address - Street 2:SUITE 490
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2578
Mailing Address - Country:US
Mailing Address - Phone:763-427-1137
Mailing Address - Fax:
Practice Address - Street 1:11850 BLACKFOOT ST NW
Practice Address - Street 2:SUITE 490
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2578
Practice Address - Country:US
Practice Address - Phone:763-427-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2024-12-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE5933207T00000X
MN57276207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery