Provider Demographics
NPI:1952797078
Name:NELSON, AUGUSTA JEAN (ATC)
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:JEAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N BLUE MOUND RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1052
Mailing Address - Country:US
Mailing Address - Phone:817-306-0914
Mailing Address - Fax:817-847-9308
Practice Address - Street 1:800 N BLUE MOUND RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-1052
Practice Address - Country:US
Practice Address - Phone:970-819-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 6552255A2300X
TXAT71032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer