Provider Demographics
NPI:1952676132
Name:NOLEN, PATRICK RYAN
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:RYAN
Last Name:NOLEN
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 1:350 WESTPARK WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3964
Mailing Address - Country:US
Mailing Address - Phone:817-398-4025
Mailing Address - Fax:817-398-4029
Practice Address - Street 1:350 WESTPARK WAY STE 103
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3964
Practice Address - Country:US
Practice Address - Phone:817-508-8030
Practice Address - Fax:817-398-4029
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4655207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350702202Medicaid
TX350702201Medicaid
TX350702202Medicaid
TX441100YKP5Medicare PIN