MEDICARE: JARED D NIELSON FNP-C

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	163W00000X	Registered Nurse	6593690-3102	UT
2	363LF0000X	Family Nurse Practitioner	6593690-4405	UT
3	363LF0000X	Family Nurse Practitioner	1053263	TX

General Provider Information

NPI Number	:	1902363831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED D NIELSON FNP-C

Provider Business Mailing Address
First Line	:	2701 HOSPITAL DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-5749
Country	:	US
Telephone Number	:	361-573-9181
Fax Number	:	361-582-5743

Provider Business Practice Location Address
First Line	:	2705 HOSPITAL DR STE 402
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-5777
Country	:	US
Telephone Number	:	361-582-7965
Fax Number	:

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

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	04/28/2026

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