Healthcare Provider Details

I. General information

NPI: 1841786969
Provider Name (Legal Business Name): PENNY NOLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 CENTRAL AVE
ASHLAND KY
41101-7423
US

IV. Provider business mailing address

2901 PIGEON ROOST RD
RUSH KY
41168-8132
US

V. Phone/Fax

Practice location:
  • Phone: 606-547-4400
  • Fax: 606-325-5151
Mailing address:
  • Phone: 606-928-6648
  • Fax: 606-928-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103902
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: