Provider Demographics
NPI:1972016327
Name:NOTHNAGEL, KAELEN (CNP)
Entity Type:Individual
Prefix:
First Name:KAELEN
Middle Name:
Last Name:NOTHNAGEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KAELEN
Other - Middle Name:
Other - Last Name:VARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 N BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1201
Mailing Address - Country:US
Mailing Address - Phone:214-947-2385
Mailing Address - Fax:214-947-2390
Practice Address - Street 1:1441 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-947-2385
Practice Address - Fax:214-947-2390
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1075248363LP2300X
OH022025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily