NPIMap

Organization Active NPI

B Nelson LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • State College, PA
National Provider Identifier
1770173858
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
B NELSON LLC
Practice address
3091 Enterprise Dr Ste 202
State College, PA 16801-3099
Phone
(610) 570-5639
NPI assigned
Jan 22, 2021
Last updated
Jan 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Bridgette Stephanie Nelson, CRNPNPI 1467735647
Title
Authorized Official
Phone
(856) 423-7700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

3091 Enterprise Dr Ste 202
State College, PA 16801-3099

Mailing address

175 W Cohawkin Rd Ste C
Clarksboro, NJ 08020-1145
Phone (856) 423-7700

Other practice location 1

150 S Warner Rd Ste 130
King Of Prussia, PA 19406-2826
Phone (610) 570-5639

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220308002829 PA Part B Supplier - Clinic/Group Practice 9537558754 Receives reassigned benefits from 2 practitioners
Practice locations: King of Prussia, PA; State College, PA

National Provider Directory

National Provider Directory

Locations

175 W Cohawkin Rd
Ste C
Clarksboro, NJ 08020

3091 Enterprise Dr
Bldg D
State College, PA 16801
Phone (814) 954-7819

3091 Enterprise Dr
Ste 202
State College, PA 16801
Phone (610) 570-5639

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1770173858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 W COHAWKIN RD STE C",
            "city": "CLARKSBORO",
            "state": "NJ",
            "postal_code": "080201145",
            "telephone_number": "856-423-7700",
            "fax_number": "856-423-0823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3091 ENTERPRISE DR STE 202",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168013099",
            "telephone_number": "610-570-5639"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 S Warner Rd Ste 130",
            "address_purpose": "LOCATION",
            "city": "King Of Prussia",
            "state": "PA",
            "postal_code": "194062826",
            "country_code": "US",
            "telephone_number": "610-570-5639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "B NELSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-22",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "BRIDGETTE",
        "authorized_official_middle_name": "STEPHANIE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "856-423-7700",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.

Verify at the official NPI Registry.