Healthcare Provider Details

I. General information

NPI: 1518159870
Provider Name (Legal Business Name): REBECCA L GREEN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA L RUNGE P.A.

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER ST STE 202
MERRIAM KS
66204-2553
US

IV. Provider business mailing address

7450 KESSLER ST STE 202
MERRIAM KS
66204-2553
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-9480
  • Fax: 913-632-9499
Mailing address:
  • Phone: 913-632-9480
  • Fax: 913-632-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number15-01210
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2007028966
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02361
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: