Active NPI
Judith A Nelson, PSY.D.
- Clinical Psychologist
- Henderson, NV
National Provider Identifier
1609081785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY0505
- Practice address
- 102 E Lake Mead Pkwy
Henderson, NV 89015-5575 - Phone
- (702) 616-4355
- NPI assigned
- May 11, 2007
- Last updated
- Oct 21, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY0505 | NV | Primary |
Addresses
Primary practice location
102 E Lake Mead Pkwy
Henderson, NV 89015-5575
Mailing address
31 Church St
Henderson, NV 89015-5331
Phone (702) 616-4355
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY0505 | NV | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508544000000",
"number": "1609081785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 CHURCH ST",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890155331",
"telephone_number": "702-616-4355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 E LAKE MEAD PKWY",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890155575",
"telephone_number": "702-616-4355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "JUDITH",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-11",
"last_updated": "2017-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NV",
"license": "PY0505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.