Provider Demographics
NPI:1316791783
Name:NELSON, KARA JO (CARE COORDINATOR)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:JO
Last Name:NELSON
Suffix:
Gender:F
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W BURLEIGH AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-9045
Mailing Address - Country:US
Mailing Address - Phone:791-955-0714
Mailing Address - Fax:
Practice Address - Street 1:115 W BURLEIGH AVE APT 209
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-9045
Practice Address - Country:US
Practice Address - Phone:791-955-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator