Healthcare Provider Details

I. General information

NPI: 1871784090
Provider Name (Legal Business Name): KRISTIN KYMYANA GREEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5646 READ BLVD STE 280
NEW ORLEANS LA
70127
US

IV. Provider business mailing address

3600 PRYTANIA ST STE 35
NEW ORLEANS LA
70115-3628
US

V. Phone/Fax

Practice location:
  • Phone: 504-246-1452
  • Fax: 504-309-4292
Mailing address:
  • Phone: 504-897-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number203427
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: