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NPI Code Detail

MEDICARE: DR. ROBERT NEVELS PH.D.

MEDICARE: DR. ROBERT NEVELS PH.D.
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
1103T00000XPsychologistMS28405MS
2103TC0700XClinical PsychologistMS28405MS
3103TP0016XPrescribing (Medical) PsychologistMP000035LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1TN 0945OTHERTNTN LICENSE #
2MS 28405OTHERMSMS LIC #

General Provider Information

NPI Number : 1548476880
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT NEVELS PH.D.
Provider Business Mailing Address
First Line : 614 WENDOVER DR
Second Line :
City : RIDGELAND
State : MS
Zip : 39157-2849
Country : US
Telephone Number : 601-853-3667
Fax Number :
Provider Business Practice Location Address
First Line : 2320 DRUSILLA LN STE E
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-1495
Country : US
Telephone Number : 225-930-4530
Fax Number : 225-930-4532
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 07/21/2022

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Directions to “ DR. ROBERT NEVELS PH.D.” Practice Location

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