Individual provider Active NPI

Mary Jean Nolan, APRN

  • Family Nurse Practitioner
  • London, KY
National Provider Identifier
1215416581
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3012318 Issued in KY
Practice address
1649 W. Hwy 192
London, KY 40741
Phone
(606) 330-0055
Fax
(606) 657-2441
NPI assigned
Aug 8, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3012318 KY Primary
Nurse Practitioner 363L00000X 3012318 KY

Addresses

Primary practice location

1649 W. Hwy 192
London, KY 40741

Mailing address

200 Road to Justice
West Liberty, KY 41472-2140
Phone (606) 743-2800

Other practice location 1

200 Road To Justice
West Liberty, KY 41472-2140
Phone (606) 743-2800 ext. 2501

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181019001425 KY Practitioner - Nurse Practitioner 1658624713 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Kentucky, PLLCGroup PAC ID 0143525998, 213 clinicians
Brock Medical, LLCGroup PAC ID 9830354638, 93 clinicians

Practice addresses (Care Compare)

1095 Morton Ave
Bardstown, KY 40004-3500
Phone (502) 601-0107

15100 N US Hwy 25E
Suite 1
Corbin, KY 40701-6449
Phone (606) 261-2054

1649 Hwy 192 W
London, KY 40741-1674
Phone (606) 330-0055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3012318KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Kentucky PLLC Family CurrentSince Mar 1, 2025 Accepting new patients
Upperline Healthcare, PC Nurse Practitioner CurrentSince Sep 1, 2025 Accepting new patients
Brock Medical, LLC Nurse Practitioner CurrentSince Sep 5, 2018 Accepting new patients
Southeastern Emergency Physicians LLC Nurse Practitioner CurrentSince Feb 1, 2022 Accepting new patients
Upperline Healthcare, PC CurrentSince Sep 1, 2025 Accepting new patients
Fast Pace Kentucky, PLLC CurrentSince Mar 1, 2025 Accepting new patients
Fast Pace Kentucky PLLC CurrentSince Sep 5, 2018 Accepting new patients

Locations

1095 Morton Ave
Bardstown, KY 40004
Phone (502) 601-0107

796 W Broadway St
Campbellsville, KY 42718
Phone (270) 572-4933

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

15100 N US Highway 25 E
Ste 1
Corbin, KY 40701
Phone (606) 261-2054

1475 Nashville Rd
Franklin, KY 42134
Phone (270) 813-1111

1649 Highway 192 W
London, KY 40741
Phone (606) 330-0055

115 Tradepark Dr
Ste A
Somerset, KY 42503
Phone (606) 678-5708

Organizations & group practices 7

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": "1533686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1215416581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ROAD TO JUSTICE",
            "city": "WEST LIBERTY",
            "state": "KY",
            "postal_code": "414722140",
            "telephone_number": "606-743-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1649 W. HWY 192",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "40741",
            "telephone_number": "606-330-0055",
            "fax_number": "606-657-2441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Road To Justice",
            "address_purpose": "LOCATION",
            "city": "West Liberty",
            "state": "KY",
            "postal_code": "414722140",
            "country_code": "US",
            "telephone_number": "606-743-2800 x2501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "MARY",
        "middle_name": "JEAN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-08",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3012318",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3012318",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

Verify at the official NPI Registry.