Healthcare Provider Details

I. General information

NPI: 1558002402
Provider Name (Legal Business Name): AUSTIN TAYLOR NOLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 515
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-603-1656
  • Fax:
Mailing address:
  • Phone: 501-202-2093
  • Fax: 501-202-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-20780
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: