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General NPI Number Information
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NPI Number | 1821624818
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Entity Type | Individual
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Provider Name | NICHOLAS JAMES NISSEN MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2020
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 3001 BEE CAVE RD STE 220
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City | AUSTIN
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State | TX
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Zip | 78746-5590
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Country | US
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Telephone | 815-354-8932
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Fax | 617-604-2403
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78731-4298
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Country | US
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Telephone | 815-354-8932
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | U6038
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License Number State | TX
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