Provider Demographics
NPI:1326327313
Name:NELSON, JAIME (PMHNP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 LOOKOUT MOUNTAIN DR.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3618
Mailing Address - Country:US
Mailing Address - Phone:512-373-6280
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX775076363LP0808X
TXAP120701363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty