MEDICARE: MS. KIRSTEN A NELSON MSN, APRN PMHNP-BC

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	163W00000X	Registered Nurse	0167066	CO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0996126-NP	CO

General Provider Information

NPI Number	:	1720442700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIRSTEN A NELSON MSN, APRN PMHNP-BC

Provider Business Mailing Address
First Line	:	1870 DUBLIN BLVD STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1264
Country	:	US
Telephone Number	:	720-504-7245
Fax Number	:	720-815-0269

Provider Business Practice Location Address
First Line	:	1870 DUBLIN BLVD STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1264
Country	:	US
Telephone Number	:	720-504-7245
Fax Number	:	720-815-0269

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

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	09/09/2022

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