NPIMap

Individual provider Active NPI

Misty Dawn Nolen, M.D.

  • Pediatrics Physician
  • Bryant, AR
National Provider Identifier
1407818271
Registry record updated May 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
E-4285 Issued in AR
Practice address
2301 Springhill Rd
Suite 200
Bryant, AR 72019-7568
Phone
(501) 315-0078
Fax
(501) 943-3016
NPI assigned
Apr 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E-4285 AR Primary

Addresses

Primary practice location

2301 Springhill Rd
Suite 200
Bryant, AR 72019-7568

Mailing address

2301 Springhill Rd
Suite 200
Benton, AR 72015-7552
Phone (501) 315-0078

Other identifiers 5

IdentifierTypeStateIssuer
7907731OtherARAETNA PROVIDER ID
156470001MedicaidAR
2539243OtherARUNITED HEALTHCARE ID#
5N108OtherARBCBS PROVIDER ID#
05040023000OtherARQUALCHOICE PROVIDER ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-4285ARMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Arkansas Pediatric Clinic Past Accepting new patients

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": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304294400000",
    "number": "1407818271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 SPRINGHILL RD",
            "address_2": "SUITE 200",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720157552",
            "telephone_number": "501-315-0078",
            "fax_number": "501-943-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 SPRINGHILL RD",
            "address_2": "SUITE 200",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720197568",
            "telephone_number": "501-315-0078",
            "fax_number": "501-943-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLEN",
        "first_name": "MISTY",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2011-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-4285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER ID",
            "identifier": "7907731",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156470001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE ID#",
            "identifier": "2539243",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID#",
            "identifier": "5N108",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE PROVIDER ID",
            "identifier": "05040023000",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryant, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.