Individual
DR. MISTY DAWN NOLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2301 SPRINGHILL RD, SUITE 200, BRYANT, AR 72019-7568
(501) 315-0078
(501) 943-3016
Mailing address
2301 SPRINGHILL RD, SUITE 200, BENTON, AR 72015-7552
(501) 315-0078
(501) 943-3016
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
E-4285
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05040023000
QUALCHOICE PROVIDER ID
AR
05
—
156470001
—
AR
01
—
2539243
UNITED HEALTHCARE ID#
AR
01
—
5N108
BCBS PROVIDER ID#
AR
01
—
7907731
AETNA PROVIDER ID
AR
Enumeration date
04/05/2006
Last updated
05/02/2011
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