Active NPI
Mary Doyle Nelson, MA, LP
- Psychologist
- Mankato, MN
National Provider Identifier
1699892745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP3743
- Practice address
- 703 Owatonna St
Mankato, MN 56001-2118 - Phone
- (507) 625-4442
- Fax
- (507) 537-0824
- NPI assigned
- Mar 23, 2007
- Last updated
- Jul 9, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP3743 | MN | Primary |
Addresses
Primary practice location
703 Owatonna St
Mankato, MN 56001-2118
Mailing address
703 Owatonna St
Mankato, MN 56001-2118
Phone (507) 625-4442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240109003617 | MN | Practitioner - Psychologist Billing Independently | 7618328113 | Practice locations: Mankato, MN |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP3743 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1699892745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 OWATONNA ST",
"city": "MANKATO",
"state": "MN",
"postal_code": "560012118",
"telephone_number": "507-625-4442",
"fax_number": "507-537-0824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 OWATONNA ST",
"city": "MANKATO",
"state": "MN",
"postal_code": "560012118",
"telephone_number": "507-625-4442",
"fax_number": "507-537-0824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "MARY",
"middle_name": "DOYLE",
"name_prefix": "Ms.",
"credential": "MA, LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-23",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP3743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.