Healthcare Provider Details

I. General information

NPI: 1588529143
Provider Name (Legal Business Name): NERVELI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 BUFFRIDGE TRL
DALLAS TX
75252-2332
US

IV. Provider business mailing address

5818 BUFFRIDGE TRL
DALLAS TX
75252-2332
US

V. Phone/Fax

Practice location:
  • Phone: 469-853-6166
  • Fax: 469-853-6166
Mailing address:
  • Phone: 469-853-6166
  • Fax: 469-853-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LEON JACOBSON
Title or Position: CEO
Credential:
Phone: 469-853-6166