Provider Demographics
NPI:1114568557
Name:JAIME NELSON PMHNP
Entity Type:Organization
Organization Name:JAIME NELSON PMHNP
Other - Org Name:BALCONES PSYCHIATRY AND MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:512-373-6280
Mailing Address - Street 1:314 E HIGHLAND MALL BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3731
Mailing Address - Country:US
Mailing Address - Phone:512-807-0640
Mailing Address - Fax:737-242-7961
Practice Address - Street 1:314 E HIGHLAND MALL BLVD STE 305
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3731
Practice Address - Country:US
Practice Address - Phone:512-807-0640
Practice Address - Fax:737-242-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1326327313OtherNPI