Active NPI
Jerry Nelson
- Addiction (Substance Use Disorder) Counselor
- Louisville, KY
National Provider Identifier
1124151428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 166933
- Practice address
- 2650 W Broadway
Louisville, KY 40211-1333 - Phone
- (502) 589-1100
- Fax
- (502) 589-8771
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 166933 | KY | Primary |
Addresses
Primary practice location
2650 W Broadway
Louisville, KY 40211-1333
Mailing address
101 W Muhammad Ali Blvd
Louisville, KY 40202-1423
Phone (502) 589-8600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 166933 | KY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466726400000",
"number": "1124151428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 W MUHAMMAD ALI BLVD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021423",
"telephone_number": "502-589-8600",
"fax_number": "502-589-8771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 W BROADWAY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402111333",
"telephone_number": "502-589-1100",
"fax_number": "502-589-8771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "JERRY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2016-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "KY",
"license": "166933",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.