Provider Demographics
NPI:1548263312
Name:NELSON, KIPER CECIL (MD)
Entity type:Individual
Prefix:DR
First Name:KIPER
Middle Name:CECIL
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3107
Mailing Address - Country:US
Mailing Address - Phone:601-264-3937
Mailing Address - Fax:601-264-5930
Practice Address - Street 1:1420 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3107
Practice Address - Country:US
Practice Address - Phone:601-264-3937
Practice Address - Fax:601-264-5930
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16844207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122476Medicaid
MS512I180022OtherMEDICARE PTAN FOR SOUTHERN EYE PHYSICIAN'S CENTER LLC
MS512I180023OtherMEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC
MS512I180022OtherMEDICARE PTAN FOR SOUTHERN EYE PHYSICIAN'S CENTER LLC
MS512I180023OtherMEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC