Provider Demographics
NPI:1912076845
Name:NOKELBY, BRYAN DAVID (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:DAVID
Last Name:NOKELBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2561 EAST CORRECTION LINE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101
Mailing Address - Country:US
Mailing Address - Phone:308-534-7293
Mailing Address - Fax:308-534-2903
Practice Address - Street 1:220 W LEOTA ST
Practice Address - Street 2:TWIN RIVERS URGENT CARE LLC
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6293
Practice Address - Country:US
Practice Address - Phone:308-534-2900
Practice Address - Fax:308-534-2903
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE20673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025335000Medicaid
NE10025335000Medicaid
G20016Medicare UPIN