Kyle Nelson, DDS, MS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D13104 Issued in MN

Practice address

1570 Adams St
Mankato, MN 56001-5192

Phone

(507) 386-0288

NPI assigned

Apr 27, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Southern Minnesota Endodontics LLC

  • Endodontics
  • Mankato, MN
  • NPI 1891308979
  NPD

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1821356841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 ADAMS ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015192",
            "telephone_number": "507-386-0288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 ADAMS ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015192",
            "telephone_number": "507-386-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KYLE",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-27",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "D13104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bariah Jean Nelson
• Gregory W. Nelson, MS, LP
• Karen J Nelson
• Kevin David Nelson, PHARMD
• Kimberlee Jo Nelson, RD, LD
• Livia Elizabeth Nelson, DC
• Lyric Taylor Nelson
• Mary Doyle Nelson, MA, LP
• Rana Nelson, LICSW
• Tarin Nelson, RN

• Endodontics in Mankato, MN
• Providers in Mankato, MN by specialty
• Endodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.