MEDICARE: MARY NELSON AGPCNP

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	364SA2200X	Adult Health Clinical Nurse Specialist	AP127511	TX

General Provider Information

NPI Number	:	1659766798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY NELSON AGPCNP

Provider Business Mailing Address
First Line	:	7817 BAYWOOD CT
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-6721
Country	:	US
Telephone Number	:	817-788-5280
Fax Number	:

Provider Business Practice Location Address
First Line	:	7817 BAYWOOD CT
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-6721
Country	:	US
Telephone Number	:	817-788-5280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	07/13/2020

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