Healthcare Provider Details

I. General information

NPI: 1356709992
Provider Name (Legal Business Name): KATHERINE LOUISE GREENE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE LOUISE GOSS

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 AMBASSADOR CAFFERY PKWY, BLDG C STE 204
LAFAYETTE LA
70508-6926
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-5239
  • Fax:
Mailing address:
  • Phone: 337-470-5239
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN.0992179-CNM
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number223217
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: