Avery John Paulson, RN, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95024036 Issued in CA

Practice address

2180 Johnson Ave
San Luis Obispo, CA 93401-4558

Phone

(805) 431-1334

NPI assigned

Dec 19, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of San Luis ObispoGroup PAC ID 9032020094, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of San Luis Obispo

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Paso Robles, CA
  • NPI 1134287634
  Medicare reassignment Care Compare group NPD
• County of San Luis Obispo

  • Adolescent and Children Mental Health Clinic/Center
  • San Luis Obispo, CA
  • NPI 1396803870
  NPD
• County of San Luis Obispo

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Arroyo Grande, CA
  • NPI 1932563053
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1013489715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014558",
            "telephone_number": "805-431-1334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "AVERY",
        "middle_name": "JOHN",
        "credential": "RN, NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-19",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95024036",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "686849",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haddasah Adrielle Paul
• Richard Paul
• Paula Defrisco, LCSW
• Linda Lois Pauli
• Mark Paulick, MD
• Peaceful Mind, Inc.
• Peak Enterprise, LLC
• Peak Vision, a Medical Corporation
• Peakmind Mental Health & Performance Wellness, Professional Nursing Corporation
• Taryn Alexandra Pearl

• Psychiatric/Mental Health Nurse Practitioner in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.