Healthcare Provider Details

I. General information

NPI: 1346755840
Provider Name (Legal Business Name): MARY PAT NELSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY PAT PALMERTON RN

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W MALLON AVE
SPOKANE WA
99260-3279
US

IV. Provider business mailing address

4709 LEADENHALL DR
NORTH CHESTERFIELD VA
23234-5321
US

V. Phone/Fax

Practice location:
  • Phone: 509-477-2278
  • Fax:
Mailing address:
  • Phone: 804-307-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number70018840
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001256707
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: