Provider Demographics
NPI:1215630777
Name:NELSON, BRIAN CHRISTOPHER
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHRISTOPHER
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 1:18200 HIGHWAY 178
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-9510
Mailing Address - Country:US
Mailing Address - Phone:661-871-9697
Mailing Address - Fax:661-871-1270
Practice Address - Street 1:18200 HIGHWAY 178
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-9510
Practice Address - Country:US
Practice Address - Phone:661-871-9697
Practice Address - Fax:661-871-1270
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker