Active NPI
William Aage Nelson
- Mental Illness Community Based Residential Treatment Facility
- St Petersburg, FL
National Provider Identifier
1699933085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- 65
- Practice address
- 714 Jackson St N
St Petersburg, FL 33705-1337 - Phone
- (727) 895-4663
- NPI assigned
- Jun 2, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 65 | FL | Primary |
Addresses
Primary practice location
714 Jackson St N
St Petersburg, FL 33705-1337
Mailing address
714 Jackson St N
St Petersburg, FL 33705-1337
Phone (727) 895-4663
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 141550600 | Medicaid | FL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65 | FL | MD | Mental Illness Community Based Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212364800000",
"number": "1699933085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 JACKSON ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337051337",
"telephone_number": "727-895-4663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 JACKSON ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337051337",
"telephone_number": "727-895-4663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "WILLIAM",
"middle_name": "AAGE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-02",
"last_updated": "2008-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "FL",
"license": "65",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "141550600",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.