Individual provider Active NPI

Laura Marie Nelson

  • Community Health Worker
  • Fresno, CA
National Provider Identifier
1619747136
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Practice address
205 N Blackstone Ave
Fresno, CA 93701-1939
Phone
(559) 538-1230
NPI assigned
Jan 5, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X Primary

Addresses

Primary practice location

205 N Blackstone Ave
Fresno, CA 93701-1939

Mailing address

205 N Blackstone Ave
Fresno, CA 93701-1939
Phone (559) 538-1230

Other practice location 1

784 W Holland Ave
Clovis, CA 93612-4800
Phone (559) 538-1230

Other practice location 2

1553 Santa Clara St
Fresno, CA 93706-3447
Phone (559) 538-1230

Other practice location 3

524 S Trinity St
Fresno, CA 93706-1873
Phone (559) 538-1230

Other practice location 4

4041 Plaza Dr W
Fresno, CA 93702-1342
Phone (559) 538-1230

Other practice location 5

1828 Broadway St
Fresno, CA 93721-1008
Phone (559) 538-1230

Other practice location 6

130 W Barstow Ave
Fresno, CA 93704-2156
Phone (559) 538-1230

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

Practice roles

OrganizationSpecialtyStatusNew patients
Exodus Recovery, Inc. Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1619747136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N BLACKSTONE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937011939",
            "telephone_number": "559-538-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N BLACKSTONE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937011939",
            "telephone_number": "559-538-1230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "784 W Holland Ave",
            "address_purpose": "LOCATION",
            "city": "Clovis",
            "state": "CA",
            "postal_code": "936124800",
            "country_code": "US",
            "telephone_number": "559-538-1230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1553 Santa Clara St",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937063447",
            "country_code": "US",
            "telephone_number": "559-538-1230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "524 S Trinity St",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937061873",
            "country_code": "US",
            "telephone_number": "559-538-1230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4041 Plaza Dr W",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937021342",
            "country_code": "US",
            "telephone_number": "559-538-1230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1828 Broadway St",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937211008",
            "country_code": "US",
            "telephone_number": "559-538-1230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 W Barstow Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937042156",
            "country_code": "US",
            "telephone_number": "559-538-1230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "LAURA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.