Provider Demographics
NPI:1437806874
Name:NOLAN, JEFFERY S
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:S
Last Name:NOLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 COLLEGE ST STE 247
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-3445
Mailing Address - Country:US
Mailing Address - Phone:409-504-8197
Mailing Address - Fax:
Practice Address - Street 1:2050 N 11TH ST STE A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-4983
Practice Address - Country:US
Practice Address - Phone:409-554-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care