Healthcare Provider Details

I. General information

NPI: 1346824711
Provider Name (Legal Business Name): KYLE D NOLAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 S TRENTON AVE
TULSA OK
74120-5420
US

IV. Provider business mailing address

1239 S TRENTON AVE
TULSA OK
74120-5420
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-2151
  • Fax: 918-588-8822
Mailing address:
  • Phone: 918-582-2151
  • Fax: 918-588-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8123
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: