Averly H Nelson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD00012481 Issued in WA

Practice address

850 Maple Street
Eastern State Hospital
Medical Lake, WA 99022-0800

Phone

(509) 565-4000

Fax

(509) 565-4705

NPI assigned

Nov 16, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Department of Social

  • Psychiatric Hospital
  • Tacoma, WA
  • NPI 1144295080
  NPD (past)
• Eastern State Hospital Pharmacy

  • Long Term Care Pharmacy
  • Medical Lake, WA
  • NPI 1679651970
  NPD (past)

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478044800000",
    "number": "1144202011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 800",
            "address_2": "EASTERN STATE HOSPITAL",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220800",
            "telephone_number": "509-565-4000",
            "fax_number": "509-565-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 MAPLE STREET",
            "address_2": "EASTERN STATE HOSPITAL",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220800",
            "telephone_number": "509-565-4000",
            "fax_number": "509-565-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "AVERLY",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2016-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00012481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1059013",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fereshteh Momeni, M.D.
• Maria Lydia Montenegro, MD
• Paul D Morrison, MD
• Teresiah Mugi
• Natural Health Ctr of Med Lake PS
• Connie Nelson
• Maureen Tara Nickerson, PSYD
• Ruth Ann Oman, ARNP
• Steven W. Palmieri, PHD, D.O.
• Taylor Pecknold, MS, RDN, CD

• Psychiatry Physician in Medical Lake, WA
• Providers in Medical Lake, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.

Verify at the official NPI Registry.