Basic Information
| Provider Information | |||||||||
| NPI: | 1851787030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLILE | ||||||||
| FirstName: | NOLAN | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 MAGNOLIA CIR | ||||||||
| Address2: | |||||||||
| City: | TYNDALL AFB | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324035604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502837511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 325 MDG | ||||||||
| Address2: | 340 MAGNOLIA CIRCLE, | ||||||||
| City: | TYNDALL AFB | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502837511 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2015 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 1664 | NE | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.