Provider Demographics
NPI:1932638756
Name:NOLAN, KENNIA ABIGAIL (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KENNIA
Middle Name:ABIGAIL
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:DR
Other - First Name:KENNIA
Other - Middle Name:ABIGAIL
Other - Last Name:MERLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT, ATC
Mailing Address - Street 1:6211 CORD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-1815
Mailing Address - Country:US
Mailing Address - Phone:479-685-3180
Mailing Address - Fax:
Practice Address - Street 1:105 S BLAIR ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764
Practice Address - Country:US
Practice Address - Phone:479-259-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2255A2300X
ARPT4808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer