| Doctor Name: | KIMBERLY M NELSON |
| NPI Number: | 1215253505 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 34005904A |
| Business Practice Address: | 1260 E Buckeye St North Vernon, IN - 472658343 |
| Business Phone Number: | 8123464468 |
| Business Fax Number: | 8123788367 |
| Mailing Address: | 645 S Rogers St, BLOOMINGTON |
| State: | IN |
| Postal Code: | 474032353 |
| Phone Number: | 8123391691 |
| Fax Number: | 8123372438 |
| NPI Enumeration Date: | 04/13/2010 |
| NPI Last Update Date: | 02/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 34005904A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |