Healthcare Provider Details

I. General information

NPI: 1528690732
Provider Name (Legal Business Name): DAWSON GREEN NP, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 S HILLSIDE ST
WICHITA KS
67211-3005
US

IV. Provider business mailing address

1026 E 14TH ST
KEARNEY MO
64060-8728
US

V. Phone/Fax

Practice location:
  • Phone: 316-364-3030
  • Fax:
Mailing address:
  • Phone: 425-457-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2020032639
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10013535
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-81608-101
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2016016282
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: