Provider Demographics
NPI:1912233198
Name:NOLAN, KIMBERLY ALICE (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALICE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 FERRARI MCLEOD BLVD
Mailing Address - Street 2:PO BOX 11130
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4385 NEIL RD STE 105
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5100
Practice Address - Country:US
Practice Address - Phone:775-325-7851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19383363LF0000X
NVAPN001159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily