Provider Demographics
NPI:1851787030
Name:CARLILE, NOLAN RICHARD (DO)
Entity type:Individual
Prefix:MR
First Name:NOLAN
Middle Name:RICHARD
Last Name:CARLILE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:59TH MEDICAL WING
Mailing Address - Street 2:1100 WILFORD HALL LOOP, BLDG 4554
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-292-7179
Mailing Address - Fax:
Practice Address - Street 1:59TH MEDICAL WING
Practice Address - Street 2:1100 WILFORD HALL LOOP, BLDG 4554
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-7179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16642084P0800X
OH58.005926390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry