Casey Nelson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20041856A Issued in IN

Practice address

1515 Magnavox Way
Fort Wayne, IN 46804-1533

Phone

(260) 408-1085

NPI assigned

Apr 23, 2007

Last updated

Dec 12, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Psychological Laboratories of Indianapolis, PC

  • Psychologist
  • Indianapolis, NE
  • NPI 1295853992
  NPD (past)

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229040000000",
    "number": "1750509667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 MAGNAVOX WAY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 MAGNAVOX WAY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041533",
            "telephone_number": "260-408-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "CASEY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2008-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20041856A",
            "primary": true
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "IN",
            "license": "20041856A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200500290",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WAVIER",
            "identifier": "200501870",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Neighborhood Home Health LLC
• Neighborhood Mentoring Academy Inc.
• Natalie Jones Neiswonger, PT
• Aaron Douglas Nelson, D.O.
• April Sue Nelson, M.A., LMHC
• Chelsea Nelson, MS
• Christina Nelson
• Grace Nelson
• Ian R Nelson, M.D.
• James B Nelson, MD

• Clinical Psychologist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.

Verify at the official NPI Registry.