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NPI Code Detail

MEDICARE: NELLY NTIM APRN-CNP, PMHNP-BC

MEDICARE: NELLY NTIM APRN-CNP, 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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN.CNP.0040403OH
2163W00000XRegistered NurseRN.531086OH
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1871304931
Entity Type Code : Individual
Provider Name (Legal Business Name) : NELLY NTIM APRN-CNP, PMHNP-BC
Provider Business Mailing Address
First Line : 1577 NEIL AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43210-1216
Country : US
Telephone Number : 614-805-6695
Fax Number :
Provider Business Practice Location Address
First Line : 1577 NEIL AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43201-2320
Country : US
Telephone Number : 614-805-6695
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2025
Last Update Date : 02/19/2026

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