Provider Demographics
NPI:1487769444
Name:NELSON, CHRISTINA D (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:D
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9784 N ASH AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-9742
Mailing Address - Country:US
Mailing Address - Phone:816-781-4244
Mailing Address - Fax:816-781-3542
Practice Address - Street 1:9784 N ASH AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-9742
Practice Address - Country:US
Practice Address - Phone:816-781-4244
Practice Address - Fax:816-782-3542
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA228481207Q00000X
MO2011034014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01100519OtherRR MEDICARE
MO14877694444Medicaid
MO14877694444Medicaid
MOP01100519OtherRR MEDICARE