Healthcare Provider Details

I. General information

NPI: 1982739199
Provider Name (Legal Business Name): RICHARD JONATHAN GREENE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 8TH ST STE 509E
MURRAY KY
42071-2403
US

IV. Provider business mailing address

300 S 8TH ST SUITE 480W
MURRAY KY
42071-2400
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-4000
  • Fax: 270-752-2857
Mailing address:
  • Phone: 270-759-4000
  • Fax: 270-752-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA670
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: