Healthcare Provider Details

I. General information

NPI: 1205220290
Provider Name (Legal Business Name): TONYA LYNN GREEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 E 138TH STE B
FISHERS IN
46037-0051
US

IV. Provider business mailing address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

V. Phone/Fax

Practice location:
  • Phone: 800-622-6575
  • Fax: 765-608-3687
Mailing address:
  • Phone: 800-622-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28155395A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005436A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: