Provider Demographics
NPI:1104001494
Name:NOLEN, RYAN CLAY (APRN,BC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CLAY
Last Name:NOLEN
Suffix:
Gender:M
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5847
Mailing Address - Country:US
Mailing Address - Phone:731-644-0474
Mailing Address - Fax:731-644-1892
Practice Address - Street 1:1004 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5847
Practice Address - Country:US
Practice Address - Phone:731-644-0474
Practice Address - Fax:731-644-1892
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2007009034-22OtherANCC
TNAPN0000013146OtherAPN