Provider Demographics
NPI:1528856614
Name:NELSON, JADYN BRYNN
Entity type:Individual
Prefix:
First Name:JADYN
Middle Name:BRYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 BETHEL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6902
Mailing Address - Country:US
Mailing Address - Phone:612-759-0314
Mailing Address - Fax:
Practice Address - Street 1:13753 NORTHWOOD DR NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3759
Practice Address - Country:US
Practice Address - Phone:612-759-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant