Provider Demographics
NPI:1215416581
Name:NOLAN, MARY JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEAN
Last Name:NOLAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ROAD TO JUSTICE
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-2140
Mailing Address - Country:US
Mailing Address - Phone:606-743-2800
Mailing Address - Fax:
Practice Address - Street 1:1649 W. HWY 192
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741
Practice Address - Country:US
Practice Address - Phone:606-330-0055
Practice Address - Fax:606-657-2441
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012318363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner