Individual provider Active NPI

Amy Marie Nolan, LCSW

  • Clinical Social Worker
  • Louisville, KY
National Provider Identifier
1104160399
Registry record updated Aug 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5153 Issued in KY
Practice address
234 Amy Ave
Louisville, KY 40212-2522
Phone
(502) 778-0001
Fax
(502) 776-1133
NPI assigned
Nov 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 5153 KY Primary

Addresses

Primary practice location

234 Amy Ave
Louisville, KY 40212-2522

Mailing address

234 Amy Ave
Louisville, KY 40212-2522
Phone (502) 778-0001

Other identifiers 1

IdentifierTypeStateIssuer
7100563550MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181214001236 KY Practitioner - Clinical Social Worker 2264777598 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5153KYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Shawnee Christian Healthcare Center Inc Clinical CurrentSince Nov 10, 2018 Accepting new patients

Locations

234 Amy Ave
Louisville, KY 40212
Phone (502) 778-0001

Interoperability endpoints

  • Direct secure messaging: amy.nolan.p1@direct.shawneechc.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566950400000",
    "number": "1104160399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 AMY AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402122522",
            "telephone_number": "502-778-0001",
            "fax_number": "502-776-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 AMY AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402122522",
            "telephone_number": "502-778-0001",
            "fax_number": "502-776-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "AMY",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-12",
        "last_updated": "2019-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "5153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100563550",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.