MEDICARE: KEVIN R MARTIN NISLY LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	4738	KS
2	1041C0700X	Clinical Social Worker	3737	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407952278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN R MARTIN NISLY LMSW

Provider Business Mailing Address
First Line	:	PO BOX 51
Second Line	:
City	:	ARLINGTON
State	:	KS
Zip	:	67514-0051
Country	:	US
Telephone Number	:	620-960-7414
Fax Number	:	888-519-0964

Provider Business Practice Location Address
First Line	:	1 N MAIN ST STE 416
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-5250
Country	:	US
Telephone Number	:	620-960-7414
Fax Number	:	888-519-0964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	03/19/2025

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