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General NPI Number Information
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NPI Number | 1932638756
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Entity Type | Individual
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Provider Name | KENNIA ABIGAIL NOLAN PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 105 S BLAIR ST
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City | SPRINGDALE
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State | AR
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Zip | 72764
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Country | US
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Telephone | 479-259-2339
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Fax |
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Provider Business Mailing Address
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Address Line | 6211 CORD AVE
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City | SPRINGDALE
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State | AR
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Zip | 72762-1815
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Country | US
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Telephone | 479-685-3180
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4808
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License Number State | AR
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