Provider Demographics
NPI:1083618706
Name:NIELSEN, JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MO PAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4021
Mailing Address - Fax:512-901-3921
Practice Address - Street 1:12221 N MO PAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4021
Practice Address - Fax:512-901-3921
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8874208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00673013OtherRR MEDICARE
TX194876201Medicaid
LAG64920Medicare UPIN
TX8K8569Medicare PIN