Healthcare Provider Details

I. General information

NPI: 1104897446
Provider Name (Legal Business Name): DIONNE R NOLAN D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WATTS ST
JONESBORO LA
71251-2062
US

IV. Provider business mailing address

121 WATTS ST
JONESBORO LA
71251-2062
US

V. Phone/Fax

Practice location:
  • Phone: 318-259-4435
  • Fax:
Mailing address:
  • Phone: 318-395-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPD197R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: