Healthcare Provider Details

I. General information

NPI: 1992634471
Provider Name (Legal Business Name): KENDALL NICHOLE GREEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 HELENA SPRINGS AVE APT G
AUGUSTA GA
30909-9337
US

IV. Provider business mailing address

3201 HELENA SPRINGS AVE APT G
AUGUSTA GA
30909-9337
US

V. Phone/Fax

Practice location:
  • Phone: 706-814-4831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP260609
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: