Provider Demographics
NPI:1699524710
Name:NELSON, JESSICA (PMHNP, MSN, RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:PMHNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 BAKER AVE UNIT 1813
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-7075
Mailing Address - Country:US
Mailing Address - Phone:651-491-4191
Mailing Address - Fax:
Practice Address - Street 1:16 3RD ST E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4573
Practice Address - Country:US
Practice Address - Phone:406-219-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT237959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health