Provider Demographics
NPI:1255730552
Name:NELSON, JESSICA R (CNM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:
Practice Address - Street 1:90 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4328
Practice Address - Country:US
Practice Address - Phone:518-792-7841
Practice Address - Fax:518-932-0289
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001818367A00000X
NYF001818367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03993895Medicaid
NY03993895Medicaid