Provider Demographics
NPI:1356914832
Name:NOLL, MATTHEW (APRN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:NOLL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 JANE BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4502
Mailing Address - Country:US
Mailing Address - Phone:937-371-5859
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-3008
Practice Address - Country:US
Practice Address - Phone:859-257-1000
Practice Address - Fax:859-323-1194
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1156459163W00000X
KY3016271363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse