Healthcare Provider Details

I. General information

NPI: 1982397725
Provider Name (Legal Business Name): KELSEE BREANN GREEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 DRAYTON AVE
ELBA AL
36323-1448
US

IV. Provider business mailing address

1875 WOODLAND DR
ELBA AL
36323-3023
US

V. Phone/Fax

Practice location:
  • Phone: 334-493-5713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-153377
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: