Healthcare Provider Details

I. General information

NPI: 1114568557
Provider Name (Legal Business Name): JAIME NELSON PMHNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 12/29/2019
Certification Date: 12/29/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E HIGHLAND MALL BLVD STE 305
AUSTIN TX
78752-3731
US

IV. Provider business mailing address

314 E HIGHLAND MALL BLVD STE 305
AUSTIN TX
78752-3731
US

V. Phone/Fax

Practice location:
  • Phone: 512-807-0640
  • Fax: 737-242-7961
Mailing address:
  • Phone: 512-807-0640
  • Fax: 737-242-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JAIME NELSON
Title or Position: OWNER
Credential: PMHNP
Phone: 512-373-6280