Provider Demographics
NPI:1144323387
Name:NELSON, VIRGINIA CARNEY (DO)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CARNEY
Last Name:NELSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1211
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-1211
Mailing Address - Country:US
Mailing Address - Phone:601-703-4282
Mailing Address - Fax:601-703-4597
Practice Address - Street 1:1702 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4140
Practice Address - Country:US
Practice Address - Phone:601-703-1481
Practice Address - Fax:601-703-1484
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16706207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121929Medicaid
MSBLUE CROSS OF MSOtherBLUE CROSS NUMBER
MS73011869OtherBLUE CROSS OF AL
MSBLUE CROSS OF MSOtherBLUE CROSS NUMBER
MS73011869OtherBLUE CROSS OF AL