Provider Demographics
NPI:1659054534
Name:NOLAN, JENNIE KATELYN (PMHNP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:KATELYN
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1737
Mailing Address - Country:US
Mailing Address - Phone:606-654-6210
Mailing Address - Fax:
Practice Address - Street 1:222 W TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1737
Practice Address - Country:US
Practice Address - Phone:606-654-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007386363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health