Wayne S Nielson, PA
Individual provider Active NPI Physician Assistant · Kanab, UT
NPI 1114253234 · NPPES record last updated Oct 23, 2009
Key facts
- NPI
- 1114253234
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 4893858-1206 (UT)
- Practice address
- 355 N Main St
Kanab, UT 84741-3260 - Phone
- (435) 644-4179
- Fax
- (435) 644-3588
- NPI assigned
- Oct 23, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200427002295 | ID | Order and Referring Only - Physician Assistant | 7618019126 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 4893858-1206 | UT | Yes |
Addresses
Primary practice location
355 N Main St
Kanab, UT 84741-3260
Mailing address
355 N Main St
Kanab, UT 84741-3260
Phone (435) 644-4179
Other providers in Kanab, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.