Provider Demographics
NPI:1316056211
Name:NELSON, DENISE THOMAS (PA-C)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:THOMAS
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 TRANSOM VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6220
Mailing Address - Country:US
Mailing Address - Phone:972-596-2025
Mailing Address - Fax:
Practice Address - Street 1:790 SE CARY PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5678
Practice Address - Country:US
Practice Address - Phone:919-443-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04827363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical