Provider Demographics
NPI:1538179205
Name:NELSON, JEANNE P (CRNP, PHD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:P
Last Name:NELSON
Suffix:
Gender:F
Credentials:CRNP, PHD
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:RENE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP, PHD
Mailing Address - Street 1:PO BOX 18084
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8084
Mailing Address - Country:US
Mailing Address - Phone:256-882-2003
Mailing Address - Fax:256-705-4630
Practice Address - Street 1:3007 MEMORIAL PKWY SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5393
Practice Address - Country:US
Practice Address - Phone:256-882-2003
Practice Address - Fax:256-705-4630
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL770103T00000X
AL1-099348363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL152484Medicaid
AL51136865OtherBLUE CROSS OF ALABAMA
AL152484Medicaid
ALP00157348Medicare PIN
AL515 52298Medicare ID - Type Unspecified
AL051532637OtherBCBS
R60593Medicare UPIN
AL051552298Medicare PIN