Michael Lee Nelson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4884511-1206 Issued in UT

Practice address

1750 N Wymount Terrace Dr
Provo, UT 84602-1017

Phone

(801) 422-5156

Fax

(801) 422-0761

NPI assigned

Sep 23, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 3

Other names 1

• Mike Nelson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12134/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brigham Young University

  dba BYU Dance

  • Family Medicine Physician
  • Provo, UT
  • NPI 1790175628
  NPD (past)
• Brigham Young University

  dba BYU Student Health Center

  • Point of Service
  • Provo, UT
  • NPI 1942276092
  NPD (past)
• In2It Medical LLC

  • Family Medicine Physician
  • Pleasant Grove, UT
  • NPI 1962879940
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1326298787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 N WYMOUNT TERRACE DR",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846021017",
            "telephone_number": "801-422-5156",
            "fax_number": "801-422-0761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 N WYMOUNT TERRACE DR",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846021017",
            "telephone_number": "801-422-5156",
            "fax_number": "801-422-0761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MICHAEL",
        "middle_name": "LEE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-23",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "4884511-1206",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SD",
            "license": "0809",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2758",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-758",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IA",
            "license": "002266",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326298787",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326298787",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326298787",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIKE",
            "last_name": "NELSON",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jordan Nelson, MD
• Kelsie Nicole Nelson
• Madison Paige Nelson
• Melanie Nelson
• Michael Bailey Nelson
• Nicole Cherie Nelson
• Sarah Meshell Nelson
• Stella Nelson
• Steven Nelson
• Morgan Claire Nephew

• Physician Assistant in Provo, UT
• Providers in Provo, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.