Kelly Neilson, is a
Physician Assistant based in Granite Shoals, Texas. Kelly Neilson is licensed to practice in Texas (license number PA20480) and his current practice location is
1505 Lakecrest Dr, Granite Shoals, Texas. He can be reached at his office (for appointments etc.) via phone at
(512) 695-3385.
NPI number for Kelly Neilson is 1457220592 and his current mailing address is 1505 Lakecrest Dr, Granite Shoals, Texas. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1457220592.
Provider's Profile
| Full Name | Kelly Neilson |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Location | 1505 Lakecrest Dr, Granite Shoals, Texas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1457220592
- Provider Enumeration Date: 11/04/2025
- Last Update Date: 06/03/2026
Medical Identifiers
Medical identifiers for Kelly Neilson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1457220592 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | PA20480 (Texas) | Primary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Neilson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kelly Neilson,
1505 Lakecrest Dr,
Granite Shoals, TX 78654-2789
Ph: () - | Kelly Neilson,
1505 Lakecrest Dr,
Granite Shoals, TX 78654-2789
Ph: (512) 695-3385 |
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