Provider Demographics
NPI:1558616623
Name:NISLEY, TIMOTHY L (RT(R))
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:NISLEY
Suffix:
Gender:M
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 COUNTY ROAD 597
Mailing Address - Street 2:
Mailing Address - City:HANCEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35077-7361
Mailing Address - Country:US
Mailing Address - Phone:256-275-4410
Mailing Address - Fax:
Practice Address - Street 1:622 COUNTY ROAD 597
Practice Address - Street 2:
Practice Address - City:HANCEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35077-7361
Practice Address - Country:US
Practice Address - Phone:256-275-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4836662471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography