MEDICARE: JONATHAN NIELSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	S5718	TX
2	207P00000X	Emergency Medicine Physician	S5718	TX

General Provider Information

NPI Number	:	1851778468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN NIELSON

Provider Business Mailing Address
First Line	:	PO BOX 733784
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-3784
Country	:	US
Telephone Number	:	682-885-6483
Fax Number	:	682-885-3113

Provider Business Practice Location Address
First Line	:	5959 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-1838
Country	:	US
Telephone Number	:	214-648-3916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	02/24/2026

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Directions to “ JONATHAN NIELSON ” Practice Location

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