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NPI Code Detail

MEDICARE: EMILY GREEN FNP

MEDICARE: EMILY GREEN FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP144562TX
2363L00000XNurse PractitionerAP144562TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1798094OTHERTXRN
2AP144562OTHERTXTX LICENSE

General Provider Information

NPI Number : 1669009858
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY GREEN FNP
Provider Business Mailing Address
First Line : 1505 LBJ FWY STE 700
Second Line :
City : DALLAS
State : TX
Zip : 75234-6065
Country : US
Telephone Number : 214-358-2300
Fax Number : 214-579-6941
Provider Business Practice Location Address
First Line : 4701 OLD SHEPARD PL STE 100
Second Line :
City : PLANO
State : TX
Zip : 75093-5295
Country : US
Telephone Number : 214-358-2300
Fax Number : 214-579-6941
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2020
Last Update Date : 09/06/2024

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