Healthcare Provider Details

I. General information

NPI: 1336371582
Provider Name (Legal Business Name): ROSALYNN NELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MAIN ST
BAR HARBOR ME
04609-1648
US

IV. Provider business mailing address

PO BOX 58484
HOUSTON TX
77258-8484
US

V. Phone/Fax

Practice location:
  • Phone: 207-288-8604
  • Fax: 207-288-8602
Mailing address:
  • Phone: 832-385-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberP4121
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA118707
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD20684
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: