Healthcare Provider Details

I. General information

NPI: 1194638122
Provider Name (Legal Business Name): KIMBERLY ANN GREEN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 SHAWNEE MISSION PKWY
FAIRWAY KS
66205-2507
US

IV. Provider business mailing address

21413 MILLRIDGE ST
SPRING HILL KS
66083-6504
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-0555
  • Fax:
Mailing address:
  • Phone: 913-306-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-86192-121
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: