Individual
AVERY NOLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1601 E. DEBBIE LANE, SUITE 2109, MANSFIELD, TX 76063
(817) 473-9125
(817) 473-9126
Mailing address
1601 E. DEBBIE LANE, SUITE 2109, MANSFIELD, TX 76063
(817) 473-9125
(817) 473-9126
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
Q6548
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
359802101
—
TX
01
—
8FS687
BLUE CROSS
TX
Enumeration date
05/02/2013
Last updated
12/08/2021
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