Mary Jaclyn Nelson, ST

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2013017730 Issued in MO

Practice address

440 E Tampa St
Springfield, MO 65806-1131

Phone

(417) 831-0150

Fax

(417) 865-3479

NPI assigned

Apr 11, 2019

Sex

Female

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

Other names 1

• Jackie McMurtrey Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Advocates for a Healthy Community Inc

  • Federally Qualified Health Center (FQHC)
  • Buffalo, MO
  • NPI 1750179610
  NPD
• Advocates for a Healthy Community, Inc

  • Federally Qualified Health Center (FQHC)
  • Springfield, MO
  • NPI 1558303057
  NPD

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1497218911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 N FOREST AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658024504",
            "telephone_number": "417-207-2580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 E TAMPA ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658061131",
            "telephone_number": "417-831-0150",
            "fax_number": "417-865-3479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MARY",
        "middle_name": "JACLYN",
        "credential": "ST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2013017730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI LICENSE",
            "identifier": "2013017730",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "MCMURTREY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Donald C. Nelson, MD
• Eric David Nelson, M.D.
• Genevieve Nelson, LPC, NCC
• Karen A. Nelson, FNP
• Kylie Nelson
• Matthew Nelson, DO
• Miranda Nelson
• Thomas Clarke Nelson, PA-C
• William P Nelson, DO
• Christine Ann Nemeti, LCSW

• Speech-Language Pathologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.