Provider Demographics
NPI:1306215355
Name:NOLAN, KYLEE (PA)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 HILLSBORO BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2599
Mailing Address - Country:US
Mailing Address - Phone:931-954-5605
Mailing Address - Fax:931-954-5606
Practice Address - Street 1:1415 HILLSBORO BLVD STE 106
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2599
Practice Address - Country:US
Practice Address - Phone:931-954-5605
Practice Address - Fax:931-954-5606
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN5195363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant