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

Nicole Audrey Nelson, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1508525411

Nicole Audrey Nelson, PHYSICIANASSISTANT is a Physician Assistant in Salt Lake City, Utah. Qualified in 2021, 5 years ago. Works from 2 locations. Licensed in Nevada and Utah.

Years since qualifying
5
Licensed in
NV, UT
In the registry since
2021
Specialties on file
2
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103
Phone: (801) 662-1619
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5440 W Sahara Ave Ste 302, Las Vegas, NV 89146-0361 — (702) 633-0207

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 14248504-1206 (UT)
Physician Assistant Taxonomy 363A00000X (NV)

Record details

NPI number1508525411
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedDecember 8, 2021
Last updated in NPPESNovember 14, 2025
Certification dateNovember 14, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Not indicated

Other providers in Salt Lake City