Provider Demographics
NPI:1548922248
Name:NELSON, MYKALA MIKESELL (DNP, FNP-C, BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:MYKALA
Middle Name:MIKESELL
Last Name:NELSON
Suffix:
Gender:F
Credentials:DNP, FNP-C, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 N 2530 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-5797
Mailing Address - Country:US
Mailing Address - Phone:801-726-0313
Mailing Address - Fax:
Practice Address - Street 1:308 E 4500 S STE 100B
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4057
Practice Address - Country:US
Practice Address - Phone:801-900-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9520322-4405363LF0000X
UT9520322-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse