Healthcare Provider Details

I. General information

NPI: 1538179205
Provider Name (Legal Business Name): JEANNE P. NELSON CRNP, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNE RENE NELSON CRNP, PH.D.

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 MEMORIAL PKWY SW
HUNTSVILLE AL
35801-5393
US

IV. Provider business mailing address

PO BOX 18084
HUNTSVILLE AL
35804-8084
US

V. Phone/Fax

Practice location:
  • Phone: 256-882-2003
  • Fax: 256-705-4630
Mailing address:
  • Phone: 256-882-2003
  • Fax: 256-705-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number770
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-099348
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: