Healthcare Provider Details

I. General information

NPI: 1659952174
Provider Name (Legal Business Name): WILLIAM GRADY NOLAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

3901 RAINBOW BLVD # MS 4015
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2614
  • Fax:
Mailing address:
  • Phone: 913-588-6400
  • Fax: 913-588-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA200938
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number333636
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number95-00023
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: