Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kevin M Nelson

Individual provider Medical Physician Assistant · NPI 1730891284

Kevin M Nelson is a Physician Assistant in Santa Rosa, California. Qualified in 2022, 4 years ago. Practices with Providence Medical Foundation, a 1,465-clinician group, accepts Medicare assignment and offers telehealth.

Years since qualifying
4
In the registry since
2022
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Practice location Address checks out

1162 Montgomery Dr Fl 2
Santa Rosa, CA 95405-4802
Phone: (707) 890-4100
Fax: (707) 476-2237
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X

Record details

NPI number1730891284
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 15, 2022
Last updated in NPPESDecember 15, 2022
Certification dateDecember 15, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Providence Medical Foundation — 1465 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

Other providers in Santa Rosa