Healthcare Provider Details

I. General information

NPI: 1740700251
Provider Name (Legal Business Name): KARLY CHRISTINE GREEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARLY CHRISTINE FATICA CRNP

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 N MERIDIAN RD
YOUNGSTOWN OH
44509-1227
US

IV. Provider business mailing address

2469 CAMELOT DR
COLUMBIANA OH
44408-9446
US

V. Phone/Fax

Practice location:
  • Phone: 330-797-0070
  • Fax: 330-797-9146
Mailing address:
  • Phone: 814-490-5563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.449510
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022907
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: