Healthcare Provider Details

I. General information

NPI: 1104010859
Provider Name (Legal Business Name): KRISTEN FRANCES NELSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 SHATTUCK AVE STE 725
BERKELEY CA
94704-1364
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 510-899-6220
  • Fax: 510-809-1974
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: