Provider Demographics
NPI:1407916760
Name:NOLAN, TIMOTHY F JR (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
Last Name:NOLAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1415
Mailing Address - Country:US
Mailing Address - Phone:859-336-3464
Mailing Address - Fax:
Practice Address - Street 1:101 MAYES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1415
Practice Address - Country:US
Practice Address - Phone:859-336-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271532084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30605018Medicaid
KY000000500349OtherANTHEM
KY0762243Medicare ID - Type UnspecifiedGRP 7622
KY30605018Medicaid
KY000000500349OtherANTHEM
KY0690946Medicare ID - Type UnspecifiedGRP 0266
KY03059298Medicare ID - Type UnspecifiedGRP 3592
KY0358698Medicare ID - Type UnspecifiedGRP 3586
KY00200001Medicare ID - Type UnspecifiedGRP 3590
KY0358798Medicare ID - Type UnspecifiedGRP 3587
KY0762341Medicare ID - Type UnspecifiedGRP 7623
KY0763541Medicare ID - Type UnspecifiedGRP 7635
KY0974714Medicare ID - Type UnspecifiedGRP 9747