McKenzie Ann Nelson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.200718 Issued in LA

Practice address

5000 Hennessy Blvd
Baton Rouge, LA 70808-4375

Phone

(225) 757-0552

Fax

(225) 763-9997

NPI assigned

Jul 9, 2014

Last updated

Mar 15, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• WK Spine & Pain Specialists

  • Interventional Pain Medicine Physician
  • Bossier City, LA
  • NPI 1982065645
  NPD (past)

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552608000000",
    "number": "1487060547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8230 SUMMA AVE STE C",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093465",
            "telephone_number": "225-757-0552",
            "fax_number": "225-753-9997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 HENNESSY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084375",
            "telephone_number": "225-757-0552",
            "fax_number": "225-763-9997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MCKENZIE",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-09",
        "last_updated": "2019-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.200718",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "PA.200718",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2370138",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kacey Lanae Nelson
• Karen M Nelson
• Kelly M Nelson, PT
• Lance Michael Nelson, P.A.
• Mark Nelson
• Michele Vidrine Nelson, LCSW
• Michelle R. Nelson
• Raymond Nelson
• Scott Kimberly Nelson, MD
• Shaundelette Nelson, NP

• Physician Assistant in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; 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.