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General NPI Number Information
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NPI Number | 1407952278
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Entity Type | Individual
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Provider Name | KEVIN R MARTIN NISLY LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1 N MAIN ST STE 416
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City | HUTCHINSON
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State | KS
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Zip | 67501-5250
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Country | US
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Telephone | 620-960-7414
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Fax | 888-519-0964
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Provider Business Mailing Address
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Address Line | PO BOX 51
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City | ARLINGTON
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State | KS
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Zip | 67514-0051
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Country | US
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Telephone | 620-960-7414
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Fax | 888-519-0964
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4738
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3737
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License Number State | KS
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