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KELLY NEILSON
NPI 1457220592
Physician Assistant in Granite Shoals, TX

Active since November 04, 2025PECOS Enrolled
1505 LAKECREST DR, GRANITE SHOALS, TX 78654(512) 695-3385 Get Directions Write a Review

NPPES record last updated: June 3, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 3, 2026, Nov 4, 2025 (2 updates tracked since 2025).

About Kelly Neilson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY NEILSON (NPI 1457220592) is an individual physician assistant in Granite Shoals, Texas, licensed in Texas (PA20480) and active in the NPI registry since November 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457220592
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameKELLY NEILSON
Location Address1505 LAKECREST DRGranite Shoals, TX 78654-2789
Mailing Address1505 Lakecrest DrGranite Shoals, TX 78654-2789
Phone(512) 695-3385
Sole ProprietorYes
Enumeration DateNovember 4, 2025
Last NPPES UpdateJune 3, 20262 updates tracked since enumeration
NPPES CertifiedJune 3, 2026
✔ NPI 1457220592 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in TX · PA20480
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1505 LAKECREST DR, Granite Shoals, TX 78654
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Neilson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78654 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$68.55 typical visit price
range $17.52 – $136.11
Typical copayment $17.13 (range $4.38 – $34.02)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Neilson's NPI number?

The NPI number for Kelly Neilson is 1457220592. It was assigned to this individual provider in the NPPES registry on November 4, 2025.

Where is Kelly Neilson located?

Kelly Neilson practices at 1505 Lakecrest Dr, Granite Shoals, TX 78654. The listed phone number is (512) 695-3385.

What is Kelly Neilson's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Kelly Neilson enrolled in Medicare?

Yes. Kelly Neilson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelly Neilson was last updated on June 3, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.