Provider Demographics
NPI:1316675093
Name:KRISTIN NELSON, LLC
Entity type:Organization
Organization Name:KRISTIN NELSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:651-964-8967
Mailing Address - Street 1:821 RAYMOND AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1525
Mailing Address - Country:US
Mailing Address - Phone:651-964-8967
Mailing Address - Fax:651-412-9442
Practice Address - Street 1:821 RAYMOND AVE STE 220
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1525
Practice Address - Country:US
Practice Address - Phone:651-964-8967
Practice Address - Fax:651-964-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1205105426OtherNPI