Provider Demographics
NPI:1619404936
Name:NOLEN, HUNTER P (MD)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:P
Last Name:NOLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N KEENE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8131
Mailing Address - Country:US
Mailing Address - Phone:573-499-4990
Mailing Address - Fax:573-442-2120
Practice Address - Street 1:105 N KEENE ST STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8131
Practice Address - Country:US
Practice Address - Phone:573-499-4990
Practice Address - Fax:573-442-2120
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024028243208800000X, 208800000X
KY56838208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300063666Medicaid
KY7100825420Medicaid
IN300063666Medicaid