Provider Demographics
NPI:1346755840
Name:NELSON, MARY PAT (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PAT
Last Name:NELSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PAT
Other - Last Name:PALMERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4709 LEADENHALL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-5321
Mailing Address - Country:US
Mailing Address - Phone:804-307-1962
Mailing Address - Fax:
Practice Address - Street 1:1100 W MALLON AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99260-3279
Practice Address - Country:US
Practice Address - Phone:509-477-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2025-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001256707163W00000X
WA70018840363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse