Provider Demographics
NPI:1487736708
Name:NELSON, RICHARD SCOTT (PA-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SCOTT
Last Name:NELSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:R.
Other - Middle Name:SCOTT
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:191 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4109
Mailing Address - Country:US
Mailing Address - Phone:828-254-0881
Mailing Address - Fax:828-254-1614
Practice Address - Street 1:191 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4109
Practice Address - Country:US
Practice Address - Phone:828-254-0881
Practice Address - Fax:828-254-1614
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00306363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487736708OtherBLUE CROSS BLUE SHIELD OF NC
NC1487736708OtherCOVENTRY HEALTH CARE, INC.
NC1487736708OtherMEDCOST
MN2640945OtherDEA
NCNC7603AMedicare PIN