Healthcare Provider Details

I. General information

NPI: 1922473313
Provider Name (Legal Business Name): JAMIE NELSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO ST SUITE 200
DURANGO CO
81301-7306
US

IV. Provider business mailing address

1 MERCADO ST SUITE 200
DURANGO CO
81301-7306
US

V. Phone/Fax

Practice location:
  • Phone: 970-382-9500
  • Fax: 970-375-0007
Mailing address:
  • Phone: 970-382-9500
  • Fax: 970-375-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0004489
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 0004489
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: