MEDICARE: R. NELSON NP IN PSYCHIATRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1114744240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R. NELSON NP IN PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	28 CLINTON ST STE 8
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 CLINTON ST STE 8
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2143
Country	:	US
Telephone Number	:	518-855-1984
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. REBEKAH NELSON
Credential	:	PMHNP
Telephone Number	:	518-855-1984

Provider Enumeration Date	:	09/20/2024
Last Update Date	:	09/20/2024

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