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General NPI Number Information
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NPI Number | 1063941268
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Entity Type | Individual
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Provider Name | PERSEPHONE NELSON PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 08/24/2025
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Provider Practice Location Address
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Address Line | 28 E MAIN ST
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-1231
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Country | US
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Telephone | 315-462-9466
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Fax |
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Provider Business Mailing Address
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Address Line | 37 ASTON VILLA
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City | NORTH CHILI
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State | NY
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Zip | 14514-9817
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Country | US
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Telephone | 585-802-7576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F406747-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | F406747-01
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License Number State | NY
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