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General NPI Number Information
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NPI Number | 1114568557
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Entity Type | Organization
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Legal Business Name | JAIME NELSON PMHNP
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 12/29/2019
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Provider Practice Location Address
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Address Line | 314 E HIGHLAND MALL BLVD STE 305
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City | AUSTIN
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State | TX
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Zip | 78752-3731
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Country | US
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Telephone | 512-807-0640
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Fax | 737-242-7961
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Provider Business Mailing Address
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Address Line | 314 E HIGHLAND MALL BLVD STE 305
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City | AUSTIN
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State | TX
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Zip | 78752-3731
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Country | US
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Telephone | 512-807-0640
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Fax | 737-242-7961
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Authorized Official
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Title or Position | OWNER
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Name | JAIME NELSON
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Credential | PMHNP
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Telephone | 512-373-6280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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