Provider Demographics
NPI:1699122507
Name:NIELSON, COLTON (MD, FAAD, ACMS)
Entity type:Individual
Prefix:DR
First Name:COLTON
Middle Name:
Last Name:NIELSON
Suffix:
Gender:M
Credentials:MD, FAAD, ACMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CHURCH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4154
Mailing Address - Country:US
Mailing Address - Phone:870-333-5145
Mailing Address - Fax:
Practice Address - Street 1:800 S CHURCH ST STE 103
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4154
Practice Address - Country:US
Practice Address - Phone:870-333-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP127207N00000X
ARE-14299207N00000X, 207ND0101X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program