Basic Information
| Provider Information | |||||||||
| NPI: | 1952676132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOLEN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 CENTRAL EXPY N STE 235 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750136135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727476042 | ||||||||
| FaxNumber: | 9727476043 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 FULLER DR STE 325 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750386530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728405511 | ||||||||
| FaxNumber: | 8556186655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Q4655 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 350702202 | 05 | TX | MEDICAID | 350702201 | 05 | TX | MEDICAID |