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General NPI Number Information
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NPI Number | 1487912887
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Entity Type | Organization
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Legal Business Name | GENA NELSON RN, MSN, PMHNP-BC PLLC
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 4511 STONEWALL ST
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City | GREENVILLE
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State | TX
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Zip | 75401
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Country | US
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Telephone | 903-454-7200
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Fax | 903-454-7204
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Provider Business Mailing Address
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Address Line | 4511 STONEWALL ST
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City | GREENVILLE
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State | TX
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Zip | 75401-5951
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Country | US
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Telephone | 903-454-7200
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Fax | 903-454-7204
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Authorized Official
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Title or Position | OWNER
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Name | MS. GENA NELSON
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Credential | RN, MSN, PMHNP
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Telephone | 214-335-5715
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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 | AP115347
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License Number State | TX
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