Provider Demographics
NPI:1144313982
Name:NOLEN, ANN LOUISE (DO)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:LOUISE
Last Name:NOLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2297
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-2297
Mailing Address - Country:US
Mailing Address - Phone:512-930-0363
Mailing Address - Fax:512-930-0371
Practice Address - Street 1:7600 HIGHWAY 29 W
Practice Address - Street 2:SUITE 5
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-6937
Practice Address - Country:US
Practice Address - Phone:512-930-0363
Practice Address - Fax:512-930-0371
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1494207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00451852OtherPTAN MEDICARE RR
TX8R9970OtherBCBS
TXDG7386OtherRAILROAD MEDICARE
TXG1494OtherLICENSE
TX0051MNOtherBCBS
TXG1494OtherLICENSE
TX8D3998Medicare PIN